Purpose: While craniosynostosis has been linked to strabismus, the association between deformational plagiocephaly (DP) and strabismus in young children remains unclear. This study aimed to investigate the potential relationship between DP and strabismus in infants and toddlers, with a focus on the impact of cranial asymmetry.
Methods: We conducted a prospective cohort study involving 134 children aged 12-31 months, including 12 with strabismus and 122 controls. Clinical characteristics including gestational age, birth weight, and mode of delivery were recorded. Cranial morphology was assessed using three-dimensional scanning, and strabismus was evaluated using the Spot Vision Screener, with ophthalmological examination as the gold standard for diagnosis. Cranial asymmetry was quantified using the Cranial Vault Asymmetry Index (CVAI), Anterior Symmetry Ratio (ASR), and Posterior Symmetry Ratio (PSR). Statistical analyses were performed to compare demographic and cranial parameters between the two groups.
Results: There were no significant differences in age, sex, gestational age, birth weight, or cranial asymmetry parameters (CVAI, ASR, control) between the groups. However, the control group exhibited significantly higher DP severity than the strabismus group (p < 0.001). Among the children with strabismus, 5 had DP, of which 4 were classified as mild and 1 as moderate. No cases severe ASR were observed in either group. 
Conclusions: This finding suggests that DP without severe ASR is not associated with an increased risk of strabismus in infants and toddlers. Future studies are warranted to explore the association between strabismus and DP in children with severe ASR.
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