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Stickler syndrome
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Stickler syndrome is an inherited disorder than can affect multiple parts of your body, including your eyes, face, ears, heart, bones and joints. The cause of Stickler syndrome is a gene mutation that affects the formation of a connective tissue called collagen. The condition is also called hereditary progressive arthro-ophthalmopathy.
Stickler syndrome is named for a Mayo Clinic doctor named Gunnar Stickler, who described the syndrome in a young boy in 1960. Stickler syndrome is usually diagnosed in young children.
If your child has Stickler syndrome, treating the signs and symptoms can help your child manage the disorder and live a more full, productive life.
Symptoms
The signs and symptoms of Stickler syndrome — and the severity of those signs and symptoms — vary widely from child to child. A combination of these signs and symptoms are common in children with Stickler syndrome:
- Severe nearsightedness. This common condition, also called myopia, is a vision disorder in which you can see near objects clearly, but objects farther away appear blurry. Children with Stickler syndrome are often born with severe nearsightedness.
- Eye problems. Several conditions, including clouding of the normally clear lens of the eye (cataracts), increased pressure in the eyeball (glaucoma), and tearing of the tissue at the back of the eye (retinal detachment) may be present at birth or occur later in children with Stickler syndrome. These conditions may impair your child's vision or, in some cases, cause blindness.
- Altered facial features. Children with Stickler syndrome often have a somewhat flattened facial structure with a small nose and a slight or absent nasal bridge. These altered features often become less distinctive with age.
- Hearing difficulties. The extent of hearing loss varies among people with this condition. The hearing loss associated with Stickler syndrome tends to worsen over time.
- Excessive joint flexibility. The ability to painlessly extend the joints beyond the normal range of motion is a characteristic of people with Stickler syndrome. As your child gets older, any extreme joint flexibility will likely lessen or disappear and your child may develop achy, swollen and stiff joints.
- Scoliosis. Scoliosis, an abnormal curvature of the spine, may be present in children with Stickler syndrome.
Other signs of Stickler syndrome may include slender arms and legs and long fingers.
When to see a doctor
Having Stickler syndrome increases your child's risk of serious eye complications. Call an eye specialist if your child experiences any of the following symptoms:
- A sudden onset or increase in floaters — tiny bits of debris floating in the eye that appear as clumps or strings
- Flashes of light in one or both eyes
- A shadow over a portion of the visual field
- A sudden blur in vision
These may be symptoms of retinal detachment, a serious eye condition requiring immediate surgical repair.
If you have Stickler syndrome and would like to have children, consider discussing your family plans with a genetic counselor. A genetic professional can explain how your disorder is inherited and its implications for your children, which may help you make informed personal decisions.
Causes
Stickler syndrome is an inherited disorder caused by mutations in certain genes involved in the formation of a protein called collagen. Collagen is the building block of many types of connective tissues, which support your body's internal structures.
Genes are segments of DNA that "code" for all of your characteristics — including traits you can see, such as eye color, and traits you can't see but that can affect your health, such as the propensity to develop high cholesterol.
You receive your genes, which occur in pairs, from your parents. One half of each pair is inherited from your mother, and the other half is from your father. Some gene pairs can be made up of one dominant gene and one recessive gene. In these instances, the effect of a dominant gene "masks" the effect of a recessive gene. This pattern of inheritance is called autosomal dominant inheritance. If a dominant gene is mutated — as in the case of Stickler syndrome — disease may result.
If you have Stickler syndrome and your partner does not, the chances that you'll pass the condition on to any of your children is 50 percent. Rarely, people may develop Stickler syndrome without inheriting a mutant gene. In these cases, Stickler syndrome results from a random mutation in one or more of your genes. It's not certain why random gene mutations occur.
Risk factors
Sticker syndrome is an inherited disorder. If you have Stickler syndrome and your partner does not, your child has a 50 percent chance — or a probability of one in two — of developing the condition.
Complications
Some of the more severe complications of Stickler syndrome may develop in your child's eyes:
- Glaucoma. Glaucoma refers to an eye disorder characterized by pressure building within your eyeball. Increased pressure pinches the nerve that relays the signal for sight from the retina to your brain (optic nerve). Untreated glaucoma will eventually cause blindness.
- Retinal detachment. This is a serious eye complication resulting from Stickler syndrome. Retinal detachment occurs when the thin layer of tissue at the back of your eye (retina) pulls away from its nourishing collection of blood vessels, called the choroid. If left untreated, blindness will result.
Other potential complications include:
- Deafness. The hearing loss associated with Stickler syndrome may become more severe over time and can eventually result in deafness.
- Osteoarthritis. Swollen and painful joints may indicate that your child has premature onset of osteoarthritis, a condition in which the cartilage in the joints deteriorates. In severe cases, hip or knee joint replacement surgery may be necessary to replace your child's damaged joints.
- Ear infections. Children with facial structure abnormalities are more likely to develop ear infections than are children with normal facial features.
- Difficulty breathing or feeding. Children born with facial abnormalities that include an opening in the roof of the mouth (cleft palate), a large tongue and a small lower jaw (Robin's syndrome), may experience difficulty feeding or breathing.
Preparing for your appointment
In some cases, the signs and symptoms of Stickler syndrome — such as facial abnormalities and eye problems — will be apparent while your child is still in the hospital after birth. Other times, your child won't be diagnosed until he or she is older.
During the initial appointment or appointments to diagnose your child, your doctor is likely to ask you a number of questions about your child's signs and symptoms. Be prepared to provide accurate answers to these questions:
- Have you noticed any clouding in your child's eyes?
- Does your child have difficulty seeing things that are far away?
- Does your child seem to have any vision problems, such as blurry vision or seeing floaters or flashing lights?
- Does your child seem to have any trouble hearing?
- Did your child start talking at a later age than expected?
During subsequent appointments, your child will likely meet with doctors who specialize in areas specific to your child's problems. Depending on your child's needs, he or she may see a specialist in eye care (ophthalmologist), in ear, nose and throat care (otolaryngologist), or in joint care (rheumatologist).
Because appointments go quickly and there's much to cover, it's a good idea to bring a list of your questions to each appointment. You might ask:
- What kinds of tests will my child need?
- What can we do at home to help manage my child's signs and symptoms?
- Do you have any brochures or other printed material on Stickler syndrome I can take home with me?
Tests and diagnosis
Your doctor may suspect Stickler syndrome based on a combination of the following signs and symptoms:
- Eye abnormalities at birth. Eye examinations help detect eye problems that are often present at birth in children with Stickler syndrome. These include a clouding of the normally clear lens of your eye (cataracts) or a defect in the jelly-like material (vitreous) filling your eye. Severe nearsightedness may be observed in older children who take vision tests.
- Impaired hearing. Your doctor may use a test called an audiogram — which measures your ability to detect different pitches and volumes of sound — to determine whether your child has experienced hearing loss.
- Altered facial features. During a physical exam, your doctor examines your child's face for features specific to Stickler syndrome — a flattened facial structure, a small nose, and a slight or absent nasal bridge. Some children also have a series of facial abnormalities that include an opening in the roof of the mouth (cleft palate), a large tongue and a small lower jaw.
- Excessive joint flexibility. Your doctor may stretch your child's arms and legs to determine the extent of his or her flexibility. If your child has Stickler syndrome, he or she may be able to extend the arms and legs beyond the range of motion that is comfortable for most people.
- Mitral valve prolapse. Mitral valve prolapse, a disorder in which one of your heart valves doesn't close properly, has been reported in people with Stickler syndrome. Your doctor may detect this condition while listening to your child's heart with a stethoscope.
Molecular genetic testing may be used to identify the mutant genes associated with Stickler syndrome, but it's not commonly used to diagnose this disorder. However, it's occasionally used to confirm a suspected diagnosis or for prenatal diagnosis.
Treatments and drugs
Treatment for Stickler syndrome focuses on addressing the signs and symptoms of the disorder. There's no cure for Stickler syndrome.
- Surgery. Babies born with a hole in the roof in their mouths (cleft palate) undergo surgery to repair the defect, usually nine months to a year after birth. During this procedure, tissue from the roof of the mouth may be stretched to cover the cleft palate. This surgery helps relieve problems feeding or breathing.
- Corrective lenses. Corrective lenses are important for treating the severe nearsightedness associated with Stickler syndrome. Some people notice better corrected vision with contact lenses than with glasses.
- Hearing aids. If your child has problems hearing, you may find that your child's quality of life is improved by wearing a hearing aid.
- Anti-inflammatory medications. Medications such as ibuprofen (Advil, Motrin, others), naproxen (Aleve, Naprosyn, others) and aspirin relieve joint swelling, stiffness and pain. Taking these medications before or after physical activity may help your child move more comfortably. However, do not give aspirin to children younger than age 14 because of the risk of Reye's syndrome.
In addition to treating any signs and symptoms, your child will likely continue seeing doctors regularly for eye exams and hearing assessments to monitor whether his or her vision and hearing change over time.
Lifestyle and home remedies
Consider these suggestions to help your child manage Stickler syndrome:
- Select your child's sports carefully. Strenuous physical activity may stress the joints, and contact sports, such as football, may increase the risk of retinal detachment. Consider avoiding these types of sports.
- Prepare for surgery. Some people with Stickler syndrome are born with a heart condition called mitral valve prolapse. If your child has mitral valve prolapse, ask your doctor whether your child needs to take antibiotics before dental or surgical procedures to reduce the risk of bacterial infections.
- Be attentive to your child's educational needs. Your child may have difficulty in school due to problems hearing or seeing. Your child's teachers need to be aware of his or her special needs.
- Stickler syndrome. Genetics Home Reference. http://www.ghr.nlm.nih.gov/condition=sticklersyndrome. Accessed Sept. 4, 2008.
- Stickler GB [expert opinion]. Mayo Clinic, Rochester, Minn. March 28, 2008.
- About Stickler syndrome. Stickler Syndrome Support Group. www.stickler.org.uk/info.htm. Accessed Sept. 4, 2008.
- Francomano C, et al. Stickler syndrome. In: Cassidy SB, et al. Management of Genetic Syndromes. 2nd ed. Hoboken, N.J.: Wiley-Liss; 2005;539-546.
