Ophthalmologic findings in patients with nonsyndromic plagiocephaly

The purpose of this article was to study the prevalence of strabismus and astigmatism in children with nonsyndromic plagiocephaly. Children with deformational plagiocephaly do not have an increased prevalence of strabismus compared with the general population but do have an increased prevalence of astigmatism, whereas children with nonsyndromic craniosynostotic plagiocephaly have an increased prevalence of strabismus and astigmatism. This observational cohort study retrospectively reviewed patients in a multidisciplinary craniofacial clinic between 1993 and 2001. Patients were referred for evaluation and management of plagiocephaly or craniosynostosis. One hundred eleven patients had deformational plagiocephaly, and 45 had synostotic plagiocephaly. Patients with lambdoid craniosynostosis, hemifacial microsomia, any syndromic form of craniosynostosis, or without a formal diagnosis were excluded. All patients underwent detailed ophthalmologic, ocular motility, and craniofacial examinations. Diagnosis was based on clinical and radiographic findings. Patients were evaluated between birth and age 14 years (mean = 13 months; SD = 22 months). Only 1 of 111 (<1%) patients with deformational plagiocephaly had an esodeviation, and none had an exodeviation. Three of 45 patients (7%) with synostotic plagiocephaly had an exodeviation, and none had an esodeviation. Eight of 93 patients (9%) with deformational plagiocephaly had unilateral astigmatism, and 14 (15%) had bilateral astigmatism (mean = 1.82 diopters). Three of 43 patients (7%) with synostotic plagiocephaly had unilateral astigmatism, and 9 (21%) had bilateral astigmatism (mean = 1.83 diopters). Patients with deformational plagiocephaly do not appear to have a higher prevalence of horizontal strabismus than the normal population. Exotropia is more common in patients with nonsyndromic craniosynostotic plagiocephaly than in the general population. The prevalence of astigmatism in patients with nonsyndromic craniosynostotic plagiocephaly appears to be greater than in the general population, but this higher prevalence requires further study.