Ocular manifestations of cerebral palsy in children attending MNH cerebral palsy clinic

Abstract

Cerebral palsy is a chronic, static impairment of muscle tone strength, coordination and movement resulting from cerebral insult before, during birth and or perinatal period. It may be associated with ocular abnormalities such as refractive errors, strabismus, nystagmus, optic atrophy andcortical visual impairment (CVI). Ocular abnormalities in children with Cerebral palsy impair learning, movements and are associated with increased dependency on care takers. If these ocular abnormalities are detected early before visual maturation has occurred and visual therapy initiated, the vision of these children can improve tremendously which, ultimately reduce the dependency on caregivers and improve the child’s quality of life. Aim To assess magnitude and pattern of ocular manifestations of Cerebral Palsy in children attending MuhimbiliNational Hospital Cerebral Palsy clinic. Methodology A hospital based descriptive cross-section study among 198 children aged 6 months up to 18 years attending Cerebral Palsy clinic at MuhimbiliNational Hospitalwas done. Study participants wereselected bysystematic random sampling followed by gathering of data through history taking, case notes review and a full ophthalmological assessment. Results There were 116 males and 82 females and the mean age was 44.2±35.8 months. Most of the studied children had spastic type of Cerebral palsy (83.4%), with birth asphyxia being the most likely cause (62.1%).About a half of the children who had attained the school going age were not enrolled in school. The overall incidence of ocular abnormalities in this study was 84%. Major ocular abnormalities identified in these cases were refractive errors 48%, nystagmus 21%, strabismus 20% and optic disc pallor 13%. Only 16% of the children with refractive errors had spectacle correction. Visual impairment was present in 74% of children, Cerebral visual impairment (CVI) was the commonest cause (80%). Ophthalmology clinic attendance prior to the study was 32% with the mean age at first attendance being 20.1 months while Physiotherapy clinic attendance was 82% and mean age at first visit was 9.8 months. Conclusion Majority of children with cerebral palsy attending the MNH CP clinic hadvisual impairment caused by different ocular abnormalities. The commonest cause of visual impairment was CVI related to birth asphyxia.Most of them had never attended ophthalmology clinic and those who had started,attended at an advanced age. Recommendation Early ophthalmological assessment for every child attending CP clinic wasproposed to recognizevisual impairment at the age where appropriate visual rehabilitation is worthwhile.