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Periocular Asymmetry in Infants with Deformational Posterior Plagiocephaly
Anna Schweigert1, Kimberly Merrill1, Ali Mokhtarzadeh1
1a The Department of Ophthalmology & Visual Neurosciences , University of Minnesota , Minneapolis , Minnesota.
Insights
Deformational posterior plagiocephaly (DPP) often causes facial asymmetry with pseudoptosis. This condition is typically non-amblyogenic, meaning it does not harm vision and requires no specific ophthalmologic intervention.
Area of Science:
- Ophthalmology
- Pediatrics
- Craniofacial Surgery
Background:
- Deformational posterior plagiocephaly (DPP) is a common infant skull deformity characterized by occipital flatness and facial asymmetry.
- Periorbital features, particularly those related to facial asymmetry, require careful evaluation in infants with DPP.
Purpose of the Study:
- To investigate the clinical significance of periorbital features in infants diagnosed with deformational posterior plagiocephaly (DPP).
- To determine the ophthalmologic implications of facial asymmetry associated with DPP.
Main Methods:
- Thirty-two infants with DPP underwent facial and cranial photography and comprehensive eye examinations.
- Four independent examiners analyzed periorbital features from patient photographs.
Main Results:
- Pseudoptosis was observed in 30 patients (94%) and pseudo-brow ptosis in 19 (59%).
- Marked pseudoptosis occurred in 17 patients (53%).
- No patients developed amblyopia; five initially misdiagnosed with congenital blepharoptosis were monitored for amblyopia until pseudoptosis was confirmed.
Conclusions:
- Infants with DPP frequently exhibit pseudoptosis and pseudo-brow ptosis contralateral to the occipital flattening.
- The pseudoptosis associated with DPP is non-amblyogenic and does not necessitate ophthalmologic intervention or routine follow-up unless other ocular abnormalities are present.
Purpose:
To analyze the clinical significance of the periorbital features associated with the facial asymmetry that is common in deformational posterior plagiocephaly (DPP).
Patients And Methods:
We identified 32 patients with DPP, photographed their faces and tops of their head, and performed a complete eye examination. Four examiners analyzed the patient's periorbital features on the photographs.
Results:
Median age was 6.5 months (range 3-12 months). Pseudoptosis was identified in 30 patients and pseudo-brow ptosis in 19. Pseudoptosis was marked in 17 patients. Five patients were misdiagnosed with congenital blepharoptosis and received regular follow-ups for amblyopia checks until the diagnosis of pseudoptosis was established. All patients had normal levator function and symmetric eyelid crease. One patient with pseudoptosis and physiologic anisocoria was diagnosed with pseudo-Horner syndrome after a negative 10% cocaine test. None of the patients developed meridional or occlusion amblyopia.
Conclusion:
DPP is the most frequent form of skull deformation in infants. Its main features are occipital flatness and facial asymmetry. Infants with DPP may present with pseudoptosis and pseudo-brow ptosis on the contralateral side of the occipital flatness. The pseudoptosis in DPP is non-amblyogenic, therefore, ophthalmologic intervention and regular follow-ups are not necessary unless other abnormalities co-exist.
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