Mental health; Stigmata; Learning disturbance; Strabismus; Stress, psychological

Stigmatism profoundly affects several factors in life to create negative stereotypes, leading to discrimination and social exclusion. Individuals exposed to stigma face significant challenges in their overall health and welfare. In a study by Link & Phelan, it was noted that people with mental health conditions who face stigma are more likely to experience difficulties in their social interactions, a significant increase in stress levels and an adverse effect on their mental well-being in the long term [1]. This exclusion perpetuates a cycle of disadvantages, further aggravated by a lack of resources, social support systems, and societal acceptance, ultimately hindering rehabilitation and future social and professional prospects [2,3].

Strabismus is a condition in which the eyes are misaligned, resulting in each eye pointing in a different direction. This condition commonly arises from abnormalities in binocular vision or impairments in the neuromuscular control of eye movements. Strabismus affects physical appearance in addition to disrupting visual development and functionality [4]. The prevalence of strabismus in children worldwide has been reported to vary between 0.14% and 5.65%, i.e., approximately 5 in 100 children aged five years have a squint [5]. In addition to physical challenges, both children and adults with strabismus frequently experience psychosocial distress, which may negatively impact their mental well-being and quality of life [6].

In Pakistan, research on strabismus within a psychosocial framework remains scarce. However, a few studies have highlighted the significant mental health challenges faced by individuals with this condition [7,8]. For instance, congenital strabismus negatively affects children's psychosocial well-being, contributing to poor self-image, reduced confidence, social isolation, and emotional distress. These effects are often worsened by cultural perceptions and stigma, which can further marginalize affected children. Notably, females tend to experience greater difficulties in social integration and dependency. Despite these insights, there is a critical gap in indigenous research exploring the mental health burden of strabismus.

The negative perception that children with strabismus are less intelligent or underskilled significantly impacts their learning ability, well-being and social interactions. This misconception lowers self-esteem and restricts emotional and cognitive development, leading to increased social anxiety, feelings of despair, and difficulty concentrating in school. Additionally, they often experience bullying by peers and exclusion from activities, which deepens their sense of isolation. A recent study by Loh & Tan revealed that children with strabismus may feel insecure or embarrassed, limiting their engagement with classmates and educational materials and hindering their cognitive and emotional development [9].

A comprehensive and integrated approach is necessary to address both the psychological and social challenges associated with strabismus. Multidisciplinary teams—including ophthalmologists, psychologists, educators, and social workers—can collaboratively address the medical, psychological, and educational aspects of a child’s welfare [10]. Early psychological interventions, vision therapy, or corrective surgery can help mitigate both emotional distress and physical symptoms [11].

For this reason, educating healthcare workers, parents, and school staff plays a crucial role in promoting early medical intervention and reducing stigma. Implementing awareness programs and providing structured psychological and social support systems can help create a more inclusive environment for children with strabismus, thereby improving their long-term psychological and social well-being.

The author herself wrote and revised the manuscript.

This research received no specific grant from the public, commercial, or not-for-profit funding agencies.

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The author declares no conflicts of interest.

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