Babies born with metopic synostosis need an eye exam, researchers say

Infants born with metopic craniosynostosis (premature fusion of the frontal suture of the skull) are more likely to develop amblyopia and should be referred to a pediatric ophthalmologist for an eye exam, according to a study published in the January 2016 issue of Cleft Palate–Craniofacial Journal. And the earlier such children are referred, the better for their vision, the researchers advised.

“Specialists treating patients with metopic craniosynostosis should be aware of the association of amblyopia with this diagnosis and make timely referrals to an ophthalmologist,” said study author Arshad R. Muzaffar, MD, Associate Professor in the Division of Plastic Surgery and the Department of Child Health at the University of Missouri School of Medicine, Columbia, MO.

Amblyopia can be successfully treated in children if detected early enough, ideally within the child’s first year.

Other studies on ocular findings of craniosynostosis have focused on patients with syndromic craniosynostosis, who generally have more severe ophthalmic complications than patients with nonsyndromic craniosynostosis. Consequently, there’s no consensus whether children with nonsyndromic craniosynostosis require referral.

The need for consensus is growing because the incidence of metopic craniosynostosis, compared with other types of synostosis, is increasing by as much as 6% per year, according to some studies. Research has reported that its incidence ranges between 1 in 15,000 to 1 in 700 newborns.

In this retrospective review, researchers included 91 children diagnosed with isolated (nonsyndromic) metopic craniosynostosis. (The institution’s practice is to refer all patients with craniosynostosis for a complete ophthalmologic evaluation.) The researchers reviewed the children’s ophthalmologic records for diagnoses of amblyopia, strabismus, and refractive error.

They found that the incidence of amblyopia was higher in these children (8.8%) than in the clinically normal pediatric population (1.5% to 1.8%). In addition, 20.9% of the children had astigmatism, 8.8% had strabismus, 5.5% had myopia, 5.5% had hyperopia, and 5.5% had anisometropia.

All of the children diagnosed with amblyopia in this study were treated with glasses or penalization therapy (occlusion or “eye patching”) when indicated. Surgical correction of strabismus was also performed when indicated. Amblyopia improved with treatment in all children.

“Early referral to a pediatric ophthalmologist for a formal eye exam and potential treatment is therefore recommended for children with isolated metopic craniosynostosis,” the researchers concluded.