Periocular Asymmetry in Patients with Deformational Plagiocephaly
Anna I. Schweigert, CO; Kimberly Merrill, CO; Ali Mokhtarzadeh, MD; Andrew Harrison, MD
Department of Ophthalmology and Visual Neurosciences, University of Minnesota
Introduction: Deformational Plagiocephaly (DP) refers to a misshapen skull in infants caused by repeated pressure to the same area of the back of the head, commonly produced by sleep position, birth trauma, torticollis, or in-utero constraint. Its main features are occipital flatness and facial asymmetry. The prevalence of amblyopia in patients with DP is similar to the general population . The purpose of this study was to identify whether there are clinically significant periocular features associated with DP.
Methods: We identified patients with DP in our ophthalmology clinic that met the criteria of occipital flatness, ipsilateral frontal bossing, and contralateral frontal flatness. The patients had their face and top of the head photographed. Four examiners analyzed the photographs and assessed the patients’ periocular features.
Results: Twenty-five patients were included (age range 3 to 12months). Pseudo-enopthalmos and pseudoptosis were detected in all patients. Nineteen patients presented pseudo-brow ptosis. All affected eyes were contralateral to the DP. None of the patients presented amblyopia. Five children came to our clinic specifically for blepharoptosis evaluation. All of them were diagnosed with pseudoptosis associated to DP. Only two of the five children returned for a follow-up, and showed improvement of the eyelid asymmetry post-helmet treatment.
Discussion: Children with DP may present non-amblyogenic periocular asymmetry consisting of pseudo-enopthalmos, pseudoptosis, and pseudo-brow ptosis as a result of the changes in the facial bones that are common in DP. Helmet therapy may improve periocular asymmetry without any ophthalmology intervention.
Conclusion: Recognizing the association between DP and periocular asymmetry may help examiners eliminate concerning conditions involving blepharoptosis in infants.
- Peitsch WK, Keefer CH, LaBrie RA, Mulliken JB. Incidence of cranial asymmetry in healthy newborns. Pediatrics. 2002;110(6):e72.
- Lee MC, Hwang J, Kim YO, Shim KW, Park EK, Lew DH, et al. Three-dimensional analysis of cranial and facial asymmetry after helmet therapy for positional plagiocephaly. Child’s Nerv Syst. 2015;31(7):1113–20.
- Gupta PC, Foster J, Crowe S, Papay F a, Luciano M, Traboulsi EI. Ophthalmologic findings in patients with nonsyndromic plagiocephaly. J Craniofac Surg. 2003;14(4):529–32.
- Moon IY, Lim SY, Oh KS. Analysis of Facial Asymmetry in Deformational Plagiocephaly Using Three-Dimensional Computed Tomographic Review. Arch Craniofac Surg. 2014;15(3):109-116.