There is a high prevalence of ocular abnormalities in children with physical and mental
disabilities which are often overlooked due to the difficulties encountered while
To describe the pattern of ocular abnormalities, their correlation with the physical
disorders and describe associated risk factors in children attending the Occupational
therapy clinic at KNH.
Cross sectional hospital based study at the Occupational therapy clinic in KNH.A
hundred and eighty seven children were examined." from both the general paediatric unit
and the sensory integration unit.
A total of 187 children were examined, males were 109(58%) and females were 78(42%).
The mean age was 2.56 years. The youngest child was 0.25 years and the oldest patient
being 13 years with a range of 12.75 years .. The majority of the children were between
one and two years, representing 45.5% of the whole group. Majority of the patients had
cerebral palsy, 160(85.6%), while ADHD and autism had almost equal proportions,
20(10.7%) and 18(9.6%) respectively. Only one child had learning disability, which
represented 0.5%. Some patients had multiple diagnoses. Among the children, 62% had
ocular anomalies. Children with CP had a much higher prevalence (58.3%) compared to
the sensory integration deficit group (3.7%). The common ocular abnormalities included
cortical visual impairment 48.7%, refractive errors 39% and squints 34.2%. Other less
frequent findings included strabismic amblopia13.4%, nystagmus 12.8%, and optic
atrophy 5.3%. Corneal scars, cataracts, maculopathy and eyelid anomalies comprised of
small proportion (5%). Association between physical disability and ocular anomalies was
noted in patients with cerebral palsy compared with sensory integration group.
Strabismus, cortical visual impairment and myopia were more likely to occur in patients
with cerebral palsy. Significant hyperopia was noted only in the cerebral palsy group.
There was no significant association noted between amblyopia, nystagmus and optic
atrophy and either of the physical disability. Some of the known risk factors for the
physical disabilities were observed to have an association with the ocular anomalies.
Strabismus and cortical visual impairment were more likely to occur in patient with
neonatal jaundice, while refractive errors in patients with congenital causes and optic
atrophy in patients with meningitis. No significant association was noted between
nystagmus, and amblyopia and any of the risk factors. Co-morbid conditions associated
with the physical conditions included speech (29.9%), epilepsy (18.7%), mental
retardation (MR) 8%, dental problems 8%, hearing loss 6.4% and breathing difficulties
Visual disabilities in children with physical disabilities were common. Cortical visual
impairment, refractive errors, squint and amblyopia, were seen in a large proportion of
these children. Children with CP had a much higher prevalence compared to the sensory
integration deficit group.
All Children with cerebral palsy and sensory integration deficits should be referred to
ophthalmologist and low vision specialist for assessment as part of a broad
multidisciplinary approach to their management. The occupational, speech and hearing
therapists should work closely with the low vision specialists in co-ordinating the
physical and ocular rehabilitation. Low vision unit should be started at KNH and
specialist should be trained to provide the much needed services to these children. Follow
up of the patients for evaluation of long term outcome of the visual interventions to be
offered with the aim of improving the quality of treatment options.