Case Report: Anisometropic Astigmatism Secondary to Unilateral Coronal Synostosis

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Craniofacial Surgery

Background:

• Craniosynostosis, a condition involving premature fusion of skull sutures, can lead to craniofacial abnormalities.
• Amblyogenic anisometropic astigmatism is a severe form of unequal refractive error that can cause permanent vision impairment if not treated early.
• Infants with craniosynostosis are at increased risk for refractive errors and subsequent amblyopia.

Observation:

• A case report details a male infant diagnosed with Pfeiffer syndrome and right unilateral coronal synostosis.
• The infant presented with significant anisometropic astigmatism, with the right eye at +2.00 diopters sphere and the left eye at +4.00 -4.75 ×170.
• Early signs of amblyopia were noted, necessitating intervention.

Findings:

• The refractive error and early amblyopia were managed with prescribed glasses.
• Following fronto-orbital advancement surgery to correct the craniofacial deformity, the patient's orbits became symmetric.
• The amblyogenic anisometropic astigmatism resolved post-surgery, and the amblyopia was successfully treated.

Implications:

• This case underscores the necessity of comprehensive cycloplegic eye examinations, including retinoscopy, for all infants diagnosed with craniosynostosis.
• Early detection and management of refractive errors and amblyopia are critical to prevent long-term visual deficits.
• Ophthalmologists and craniofacial surgeons should collaborate to ensure timely interventions for these high-risk patients.