Abstract
Purpose :
We sought to determine prevalence and types of strabismus in children with craniosynostosis, as well as effects of major and minor cranial suture involvement and craniofacial surgery. Limited published data describe these prevalences.
Methods :
Retrospective cohort study of children with craniosynostosis over an 11-year period. Primary outcomes were prevalence and types of strabismus overall, among subtypes of craniosynostosis determined by imaging and intraoperative findings, and pre/post craniofacial surgery.
Results :
726 children with craniosynostosis were studied; mean age 2.9 years (SD 3.7), mean follow-up 3 years (SD 3), 37% syndromic/genetic association. 44% had sagittal fusion, 41% coronal, 31% metopic, 11% lambdoid, 9% minor suture(s). 82% had one major suture fused, 17% had 2-4 sutures. 56% underwent craniofacial surgery. Overall, 261 (36%) children had strabismus, of whom 18% had exotropia, 12% esotropia, 11% vertical, 20% inferior oblique overaction. Considering pre-craniofacial-surgery exams, if one major suture was fused, strabismus risk was 15-18%, except for coronal, which was 47%. Strabismus prevalence increased with number of fused major sutures (30% for 1, to 70% for all 4). Craniofacial surgery increased strabismus (26% versus 33%, p=0.03), but some pre-op strabismus resolved postoperatively. Vertical strabismus was associated with unilateral (36%) versus bilateral coronal synostosis (9%, P<0.001). Exotropia was associated with minor suture fusion (32% vs. 16%, p=0.01).
Conclusions :
Craniosynostosis carries a 36% risk of strabismus, a 15-fold increase versus the general population, and this risk varies with number and type of sutures involved.
This is a 2021 ARVO Annual Meeting abstract.