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PC Gupta, J Foster, S Crowe, F Papay, M Luciano, EI Traboulsi; Ophthalmologic Findings in Patients with Non-Syndromic Plagiocephaly . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3845.
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Purpose: To study the prevalence of strabismus and astigmatism in children with non-syndromic plagiocephaly. Design: Observational cohort study. Methods: Setting: Restrospective study of patients in a multidisciplinary craniofacial clinic between 1993 and 2001. Patient Population: Patients were referred for evaluation and management of plagiocephaly and/or craniosynostosis. 111 patients had deformational plagiocephaly and 45 had synostotic plagiocephaly. Patients with lambdoid craniosynostosis, those without a formal diagnosis and those with a syndromic form of craniosynostosis were excluded. Observation Procedures: All patients underwent detailed ophthalmologic, ocular motility and craniofacial examinations. Diagnosis was based on clinical and radiographic findings. Results: Patients were evaluated between birth and 14 years of age (mean= 13 months; S.D.= 22 months). 53 patients were female and 103 were male. 147 patients were Caucasian, 5 patients were African-American, and 4 patients were of Asian descent. Only 1 of 111 (<1%) patients with deformational plagiocephaly had an esodeviation, and none had an exodeviation (95% upper confidence bound if prevalence in the normal population is 4.4% using binomial distribution). 3 of 45 patients (7%) with synostotic plagiocephaly had an exodeviation, and none had an esodeviation (one sided p value = 0.01 for strabismus compared to approximate 1% prevalence in the normal population). 8 of 93 patients (9%) with deformational plagiocephaly had unilateral astigmatism, and 14 (15%) had bilateral astigmatism (mean = 0.43 diopters) (one sided p-value = 0.127 with z distribution = 1.14 for all astigmatism compared to 19% prevalence in the normal population). 3 of 43 patients (7%) with synostotic plagiocephaly had unilateral astigmatism, and 9 (21%) had bilateral astigmatism (mean = 0.51 diopters) (one sided p-value = 0.069 with z distribution = 1.48 for all astigmatism compared to the 19% prevalence in the normal population). Conclusions: 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 non-syndromic craniosynostotic plagiocephaly than the general population. The prevalence of astigmatism in patients with non-syndromic craniosynostosic plagiocephaly appears to be greater than the general population but this higher prevalence requires further study.
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