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. 2025 Oct 23;17(10):e95277.
doi: 10.7759/cureus.95277. eCollection 2025 Oct.

Visual Impairment and Ocular Findings in Children With Developmental Delay Attending a Child Development Unit Clinic at a Tertiary Hospital

Monika Singh  1 , Miriam A Clement  1 , Gowtham Kim  1 , Gayathri J Panicker  1 , Somreeta Bhattacharya  2 , Radha Annamalai  1
Affiliations

Visual Impairment and Ocular Findings in Children With Developmental Delay Attending a Child Development Unit Clinic at a Tertiary Hospital

Monika Singh et al. Cureus. .

Abstract

Introduction Childhood blindness is largely attributable to preventable causes. In children with developmental delay, identifying ocular morbidity is particularly challenging due to limited cooperation and associated comorbidities. This study aimed to determine the prevalence and spectrum of refractive errors, strabismus, and other ocular findings among children with developmental delay attending a tertiary care center in South India, and to highlight the importance of early ophthalmic screening in this population. Methods This retrospective review included 100 preschool children with developmental delay (aged four months to five years) presenting to the ophthalmology outpatient department of a tertiary care center in South India over a period of two years. Visual impairment was defined as visual acuity below the age-appropriate expected level despite best correction, or, in uncooperative children, based on abnormal fixation behavior and inability to maintain central, steady fixation. Evaluation included visual acuity testing, refraction, ocular alignment assessment, and comprehensive ophthalmic examination. Results Visual impairment was observed in 66 (66%) children (95% CI: 56-75). Refractive errors were identified in 84% (95% CI: 75-90) of the cohort, with hypermetropia being the most frequent subtype (65, 78%), followed by myopia (15, 18%) and astigmatism (38, 45%). Strabismus was detected in 12% of children, most frequently exotropia. Causes of developmental delay included prematurity (69%), syndromic associations such as Down syndrome (10%), and miscellaneous factors (21%). Conclusion Nearly two-thirds of children with developmental delay had visual impairment, predominantly due to refractive errors and strabismus. Early ophthalmic screening and timely management are essential to reduce preventable visual disability and improve neurodevelopmental outcomes in this vulnerable group.

Keywords: developmental delay; exotropia; hypermetropia; ocular alignment; refractive error; strabismus; visual impairment.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Research Ethics Committee, Sri Ramachandra Institute of Higher Education and Research, Chennai issued approval CSP-MED/24/JAN/97/07. Written informed consent was obtained from parents or legal guardians of all participants for identifiable clinical photographs. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Nine gaze pictures showing a comitant left exotropia of 45 prism diopters (PD) and full extraocular movements in a five-year-old girl with global developmental delay
Figure 2
Figure 2. A 2.5-year-old boy with hypoxic ischemic encephalopathy sequelae with a large left comitant esotropia of 60 prism diopters (PD) with left dissociated vertical deviation and right-sided head tilt, and no significant refractive error
See this image and copyright information in PMC

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