Ocular motility improvement in Crouzon syndrome after neurosurgical intervention without strabismic operation

Abstract

We report a case of craniosynostosis showing spontaneous improvement in presumed superior oblique palsy and V-pattern exotropia in long-term follow-up. A 3-year-old girl who presented with head-face anomaly, V-pattern exotropia and abnormal head posture was admitted to our clinic. The diagnosis of Crouzon syndrome was established, and bilateral coronal suture excision and decompression were made by neurosurgeons. After the cranial operation, the patient was followed up for 6 years without further cranial or strabismic operation. At the end of this period, we observed that corrected visual acuity was 20/20 in both eyes and her ocular deviation disappeared in all gaze positions. Strabismus in craniosynostosis may be related to anatomical malposition of the rectus muscles. Spontaneous improvement in ocular deviation may occur, therefore, this possibility must be considered in the planning of surgical intervention.