The familial nature of simple strabismus has led to numerous hypotheses regarding its inheritance. The highly variable clinical manifestations and the lack of specific diagnosis criteria for the classification of strabismus have, however, led to generally inconclusive and conflicting results. Of the three major mechanisms known to result in genetic disease, only multifactorial inheritance satisfactorily accounts for the observed distribution of most familial cases. Nevertheless, proof of this mechanism remains to be established since most investigations lack sufficient pedigree data. With the aid of more quantitative strabismus measurements together with expanded pedigree and population data collections, it is reasonable to anticipate clarification of the role of genetic factors in the etiology of strabismus in the near future.
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