title: Ocular and orbital manifestations of the inherited bone marrow failure syndromes: Fanconi anemia and dyskeratosis congenita.
abstract: OBJECTIVE
  The inherited bone marrow failure syndromes (IBMFS) are a heterogeneous group of genetic disorders that share the inability of the bone marrow to produce an adequate number of blood cells. The 4 most frequent syndromes are Fanconi anemia (FA), dyskeratosis congenita (DC), Diamond-Blackfan anemia (DBA), and Shwachman-Diamond syndrome (SDS). All 4 syndromes have been associated with various physical abnormalities. As part of a genotype/phenotype/cancer susceptibility study, we determined the prevalence of ophthalmic manifestations in these 4 syndromes.
  
  
  METHODS
  Cross-sectional study of a patient cohort.
  
  
  METHODS
  Seventy-five patients with an IBMFS and 121 of their first-degree relatives were seen in the National Eye Institute, National Institutes of Health, from 2001 to 2007. The patient group included 22 with FA, 28 with DC, 19 with DBA, and 6 with SDS.
  
  
  METHODS
  Every participant underwent a complete ophthalmic evaluation and digital facial photography with an adhesive paper ruler on the patient's forehead for an internal measure of scale. Interpupillary distance (IPD), inner canthal distance (ICD), outer canthal distance (OCD), palpebral fissure length (PFL), and corneal diameter (CD) were measured. Thirteen of the 22 patients with FA underwent axial length (AL) measurements by A-scan ultrasonography.
  
  
  METHODS
  Type and prevalence of ophthalmic manifestations.
  
  
  RESULTS
  Ninety-five percent of patients with FA had at least 1 abnormal parameter, and 25% of patients had at least 4 abnormal parameters. Eighty-two percent of patients had small palpebral fissures, 69% of patients had simple microphthalmia, 64% of patients had small OCD, 55% of patients had microcornea, 28% of patients had ptosis, and 6% of patients had epicanthal folds. In patients with DC, abnormalities of the lacrimal drainage system (29%) were the most prevalent findings, followed by retinal abnormalities (pigmentary changes, retinal neovascularization, retinal detachment, exudative retinopathy) in 21%, cicatricial entropion with trichiasis and blepharitis in 7% each, and sparse eyelashes and congenital cataract in 3.5% each. No significant ophthalmic abnormalities were seen in patients with DBA or SDS.
  
  
  CONCLUSIONS
  Syndrome-specific ocular findings are associated with FA and DC and may antedate diagnosis of the specific syndrome. Early recognition of these abnormalities is important for optimal management.
authors.affiliation: Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. tsiloue@nei.nih.gov
authors.forename: Ekaterini T
authors.initials: ET
authors.lastname: Tsilou
authors.forename: Neelam
authors.initials: N
authors.lastname: Giri
authors.forename: Sarah
authors.initials: S
authors.lastname: Weinstein
authors.forename: Christine
authors.initials: C
authors.lastname: Mueller
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Savage
authors.forename: Blanche P
authors.initials: BP
authors.lastname: Alter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D029503:Anemia, Diamond-Blackfan / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019871:Dyskeratosis Congenita / Q000150:complications*; D005124:Eye Abnormalities / Q000209:etiology*; D015785:Eye Diseases, Hereditary / Q000209:etiology*; D005199:Fanconi Anemia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000209:etiology*; D010375:Pedigree; D015995:Prevalence; D055815:Young Adult