Ptosis and Craniosynostosis: Revisiting Syndromic and Surgical Associations.

Ocular manifestations, including ptosis, have been associated with certain craniosynostosis syndromes, though the precise relationships with diagnosis and treatment remain unclear. This study examines the prevalence and correlates of ptosis in craniosynostosis. A retrospective cohort study was conducted on all patients with craniosynostosis examined by an ophthalmologist in a tertiary care craniofacial clinic between 2009 and 2024. Chart review was performed to collect medical and surgical history, ptosis diagnosis, and cranial suture involvement, and data was compared with appropriate statistical methods. A total of 1547 patients with craniosynostosis were included in our cohort. In all, 151 (9.8%) had a craniosynostosis syndrome, and 157 (10.1%) had ptosis. Saethre-Chotzen [odds ratio (OR): 5.29, P<0.001], Pfeiffer (OR: 3.90, P=0.013), and Crouzon (OR: 2.76, P=0.032) syndromes were associated with ptosis, while Muenke (OR: 1.14, P=0.822) and Apert (OR: 1.36, P=0.530) were not. Among cranial sutures, the coronal suture was the only suture associated with ptosis (OR: 2.49, P<0.001), independent of syndromic status. Ptosis in craniosynostosis patients was found to be associated with Saethre-Chotzen, Pfeiffer, and Crouzon syndromes, coronal suture synostosis, anterior vault surgery, and fronto-facial surgery. Recognizing these associations is essential for guiding future research into the underlying pathophysiological mechanisms of ptosis in craniosynostosis, with the goal of improving strategies for prevention and treatment.