Theo Nash
Fetal Alcohol Syndrome (FAS) is a permanent condition caused by maternal alcohol consumption during pregnancy. It can cause a range of physical and mental defects, including abnormal facial features such as small eyes and a smooth ridge between the nose and upper lip. The eye is a sensitive indicator of FAS, with various abnormalities observed, including short palpebral fissures, telecanthus, epicanthus, blepharoptosis, microphthalmos, and strabismus. These abnormalities can lead to vision problems, with reduced visual acuity observed in over half of children with FAS. The detrimental effects of alcohol on the fetal eye are important for both diagnosis and management, and an ophthalmological examination is recommended for suspected cases of FAS.
| Characteristics | Values |
|---|---|
| Fetal Alcohol Syndrome (FAS) | Caused by chronic maternal alcohol consumption during pregnancy |
| FAS diagnosis | Based on the presence of characteristic facial dysmorphism, postnatal growth retardation, and functional or structural central nervous system deficits |
| Eye abnormalities | Present in over 90% of children with FAS |
| Palpebral fissure length | Shorter than normal |
| Distance between inner and outer corners of each eye | Shorter than normal |
| Fundus abnormalities | Optic nerve hypoplasia, increased tortuosity of the retinal vessels, disturbed retinal function |
| Ophthalmic examination | Recommended for all children suspected of having FAS |
| Examination components | Inspection of periocular features, visual acuity, slit lamp exam, ophthalmoscopic exam |
| Visual acuity | Reduced in children with FAS |
| Eye movement tasks and eye tracking measures | Potential tools for assessing FAS |
| Vision problems | Near or far-sightedness, reduced visual acuity, vision loss |
| Eyelid abnormalities | Short palpebral fissures, telecanthus, epicanthus, blepharoptosis, ptosis |
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What You'll Learn
- Fetal Alcohol Syndrome (FAS) is caused by maternal alcohol misuse during pregnancy
- FAS can cause a wide range of symptoms, including behavioural, mental, and physical issues
- Eye abnormalities are common in FAS, with over 90% of children with the condition presenting them
- These abnormalities can include short palpebral fissures, telecanthus, epicanthus, blepharoptosis, microphthalmos, and strabismus
- A full ophthalmic examination is recommended for all children suspected of having FAS
Fetal Alcohol Syndrome (FAS) is caused by maternal alcohol misuse during pregnancy
Fetal Alcohol Syndrome (FAS) is a permanent condition that arises when a pregnant woman consumes alcohol. Alcohol use during pregnancy can interfere with the baby's development, causing physical and mental defects. The effects of FAS on the eye are less well-known than its other manifestations, but they are common and significant for diagnosis and treatment.
FAS can cause a range of eye issues, including physical abnormalities and problems with vision. One of the most common eye abnormalities in FAS is small eyes, which can also make the eyes appear more widely spaced than they are. This condition is known as telecanthus and is characterised by a widened distance between the inner corners of the eyes. Another common feature is short palpebral fissures, or smaller eyelid openings, which can also be challenging to detect due to confounding factors such as microcephaly. The fundus may also exhibit various abnormalities, with optic nerve hypoplasia and increased tortuosity of the retinal vessels being the most prevalent findings.
The detrimental effects of alcohol on the fetal eye are significant, and an ophthalmological examination is crucial for diagnosis and management. Eye movement tasks and eye-tracking measures can be used to assess FAS in children, and visual acuity tests may reveal reduced visual acuity, or the ability to see detail, in those with FAS.
FAS is caused by maternal alcohol misuse during pregnancy, and it is important for pregnant women to avoid excessive alcohol consumption. While the relationship between alcohol and teratogenesis is clear, the threshold for safe alcohol consumption during pregnancy is still uncertain. The Royal College of Obstetricians and Gynaecologists (RCOG) recommends that pregnant women abstain from drinking excessive amounts of alcohol, but there is no conclusive evidence that consuming 1 to 2 units once or twice a week is harmful. Nonetheless, full disclosure of maternal alcohol consumption during pregnancy is crucial for the healthcare provider and the baby's pediatrician to plan for the child's future.
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FAS can cause a wide range of symptoms, including behavioural, mental, and physical issues
Fetal Alcohol Syndrome (FAS) is a condition that occurs when a pregnant woman consumes alcohol during her pregnancy. It can cause a wide range of symptoms, including behavioural, mental, and physical issues. The severity of these symptoms can vary from mild to severe and can be difficult to diagnose due to the variety and range of symptoms presented.
Behavioural issues associated with FAS can include impulsiveness, inattentiveness, and challenges with judgment and school performance. These issues can impact a person's social life, education, and work, often requiring specialised support and accommodations.
Mental challenges are also common in individuals with FAS. These can include cognitive impairments, learning disabilities, and difficulties with memory, attention, and problem-solving. People with FAS may also experience mental health issues such as anxiety, depression, and difficulties regulating emotions.
Physical abnormalities are often present in people with FAS, affecting various parts of the body. Common physical traits associated with FAS include abnormal facial features, such as a smooth ridge between the nose and upper lip, a thin upper lip, and small eyes. The eyes, in particular, can show several abnormalities, with over 90% of children with FAS presenting with eye abnormalities. These can include a shortened distance between the inner and outer corners of the eyes, known as short palpebral fissures, and abnormalities at the back of the eye, such as hypoplasia of the optic nerve and increased tortuosity of the retinal vessels. Other physical abnormalities can affect the heart, skeletal system, ears, and kidneys.
The symptoms of FAS are lifelong and currently have no cure. However, early diagnosis and intervention can help manage the symptoms and improve the quality of life for individuals with FAS. Prevention is crucial, and healthcare providers emphasise the importance of abstaining from alcohol during pregnancy to eliminate the risk of FAS entirely.
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Eye abnormalities are common in FAS, with over 90% of children with the condition presenting them
Fetal Alcohol Syndrome (FAS) is a condition that arises when a pregnant woman consumes alcohol. It can cause a range of issues, including abnormal facial features, growth retardation, and neurobehavioral impairments. FAS is a severe form of fetal alcohol spectrum disorder (FASD) and is the most common non-inherited cause of learning disabilities.
Eye abnormalities are highly prevalent in FAS, with over 90% of affected children presenting them. These abnormalities can serve as a sensitive and reliable marker for FAS diagnosis. The most common ocular findings include:
- Optic nerve hypoplasia, where the optic nerve fails to develop normally.
- Tortuosity of the retinal blood vessels, leading to increased tortuosity.
- Strabismus, an abnormal alignment of the two eyes, with one eye turning inward, outward, upward, or downward.
- Ptosis, or blepharoptosis, characterized by drooping of the upper eyelid.
- Microphthalmos, resulting in abnormally small eyes.
Less frequent ocular abnormalities associated with FAS include:
- Duane's retraction syndrome.
- DiGeorge syndrome.
- Anterior segment anomalies such as corneal opacities, cataracts, glaucoma, and Axenfeld's and Peters' anomalies.
Given the high occurrence of eye abnormalities in FAS, an ocular examination can be a valuable tool in diagnosing the condition. A full ophthalmic examination is recommended for children suspected of having FAS or exposure to maternal alcohol consumption during pregnancy. This examination includes inspecting periocular features, measuring visual acuity, performing a slit lamp examination, and conducting an ophthalmoscopic examination with a focus on the optic disc and retina vasculature.
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These abnormalities can include short palpebral fissures, telecanthus, epicanthus, blepharoptosis, microphthalmos, and strabismus
Fetal Alcohol Syndrome (FAS) is a condition caused by chronic maternal alcohol consumption during pregnancy. It is the most common non-inherited cause of learning disabilities. Eye abnormalities occur in over 90% of children with FAS, and these abnormalities can include short palpebral fissures, telecanthus, epicanthus, blepharoptosis, microphthalmos, and strabismus.
Short palpebral fissures refer to a shortened distance between the inner and outer corners of each eye. Normal palpebral fissure length is provided by the Hall Caucasian Charts. Objective methods such as ocular axial length measurement under ultrasonography may be necessary for detection.
Telecanthus, or dystopia canthorum, refers to an increased distance between the inner corners of the eyelids (medial canthi) while the inter-pupillary distance is normal. This is in contrast to hypertelorism, in which the distance between the whole eyes is increased. Telecanthus is often associated with many congenital disorders, including fetal alcohol syndrome.
Epicanthus refers to epicanthal folds, which begin above the upper tarsus and extend to the inferior orbital rim. Epicanthal folds are especially common among certain ethnicities, including East Asians, Southeast Asians, Central Asians, Polynesians, and Indigenous peoples of the Americas.
Blepharoptosis is an abnormal low-lying upper eyelid margin with the eye in primary gaze. It results from a dysfunction of one or both upper eyelid elevator muscles. Patients usually present with a complaint of the involved eye being small, having a tired appearance, causing a limitation of the field of vision, and headaches. Blepharoptosis can be congenital or acquired.
Microphthalmos refers to abnormally small eyes, which is a frequent finding in FAS. Microphthalmos can be associated with intellectual disability, craniofacial malformations (such as cleft lip/palate or microcephaly), and malformations of the hands and feet (polydactyly). It can occur in isolation or be syndromic.
Strabismus, or crossed eyes, is a condition in which both eyes do not look at the same place at the same time. It usually occurs due to poor eye muscle control or farsightedness. Strabismus usually develops in infants and young children but can also occur in older children and adults. It is a common condition, with many types, and can worsen without treatment.
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A full ophthalmic examination is recommended for all children suspected of having FAS
Fetal Alcohol Syndrome (FAS) is an irreversible congenital condition caused by chronic maternal alcohol consumption during pregnancy. The detrimental effects of alcohol on fetal eyes are common and important from both a diagnostic and management perspective. The eye is a sensitive and reliable marker of teratogenesis and provides a useful adjunct to the diagnosis of FAS, with eye abnormalities having been shown to occur in over 90% of children.
The most common eye abnormalities in children with FAS include:
- Short palpebral fissure length (a shortened distance between the inner and outer corners of each eye)
- Visual impairment
- Epicanthus
- Subnormal stereoacuity
- Abnormal retinal tortuosity
- Impaired fixation ability
- Telecanthus
- Optic nerve hypoplasia
- Small optic discs
- Inspection of periocular features, which may include morphometric analysis
- Visual acuity testing, which may include visual evoked potentials
- A slit lamp exam
- An ophthalmoscopic exam with particular attention to the optic disc for signs of hypoplasia and the retina vasculature for signs of tortuosity
Visual acuity can aid in diagnosis, as children with FAS tend to have reduced best-corrected visual acuity. Eye movement tasks and eye tracking measures are other potential tools for assessing FAS in children and measuring executive function in FAS patients. Providing an FAS diagnosis earlier in life through an eye exam can help manage the disease overall and reduce both ocular comorbidities (vision loss) and cognitive/neurobehavioral comorbidities.
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Frequently asked questions
FAS is a permanent condition that arises when a pregnant woman consumes alcohol. It can cause lifelong physical and mental defects in the child.
Symptoms of FAS include abnormal facial features, such as small eyes, a smooth ridge between the nose and upper lip, and a thin upper lip. Other symptoms include low body weight, short height, sleep and sucking difficulties, and small head size.
FAS can cause physical abnormalities in the eyes, including short palpebral fissures (smaller eyelid openings), telecanthus (widened distance between the inner corners of the eyes), and epicanthal folds (larger than normal skin folds near the inner corner of the eye). It can also lead to issues with sight and vision, such as nearsightedness or farsightedness, and reduced visual acuity.
FAS can be difficult to diagnose, and there is no direct test for it. Pediatric providers may make a diagnosis based on the child's size, specific physical signs, and symptoms that develop through childhood. An ophthalmological examination is often recommended as the eyes can be a sensitive indicator of the adverse effects of alcohol exposure during pregnancy.
