Objective:
What is the impact of the osteopathic treatment on the severity of the squint-angle in children with congenital or infantile esotropia?

Study Design:
The study followed a randomized controlled clinical design.

Setting:
The study took place in the Düsseldorf/Bad Neuenahr area. Patients were referred by local ophthalmologists, opticians, ophthalmic hospitals, and Kindergartens.

Patients:
Sixty children (one to six years, mean 4 years) with medically diagnosed congenital or infantile esotropia. The group was divided into an intervention and a control group (thirty children each) by external randomization. The intervention group had two drop outs.

Intervention:
The intervention group received four osteopathic treatments in intervals of two weeks. The osteopathic examination was carried out without a defined concept (“black-box-principle”). The osteopathic dysfunctions, diagnosed during the first visit, were individually treated according to the principals of osteopathy in the cranial, visceral and parietal system. The control group did not receive any osteopathic treatment. Occlusion therapy was permitted in both groups as amblyopia-prophylaxis.
Main outcome parameter:
Severity of the squint-angle (distant- and proximity-angle), measured with the prism-cover-test. The measurements were conducted by the treating orthoptist.

Results:
The distant-angle measured in the intervention group showed an average reduction of 2.4° (from 20.5° to 19.1°). These results equal an improvement of 6.8% (p = 0.174, 95% CI = -0.6 to 3.3). The control group showed no improvement regarding the distant-angle. The proximity-angle in both groups was nearly unchanged. The comparison of both groups showed no statistic significance.

Conclusion:
In this study there was no clinically relevant improvement regarding the squint-angle through osteopathic treatment. Possible explanations could be:
1.) Diagnosing the child as early as possible (within the first year of life) might ensure a timely and therefore more effective osteopathic treatment.
2.) An extended treatment period might show more valuable osteopathic results.
3.) More measurements of the squint-angle into the osteopathic treatment contribute to the objectivity of the treatment results. Therefore a natural variability of the squint-angle is also being taken into account.