Owing to the multi-system nature of the disease, people with Stickler syndrome present with a variety of clinical features, the most common amongst them being ophthalmological abnormalities, hearing deficits, a distinctive facial appearance and multiple musculo-skeletal defects.

A frequent eye finding seen in Stickler syndrome is vitreoretinal degeneration, that causes floaters to appear in an individual's field of vision [1]. Patients thus, become more prone for partial/ complete retinal detachment, that may manifest as flashes, floaters or sudden blindness. Cataracts, astigmatism and strabismus also contribute to the decrease in visual acuity. Glaucomatous changes have been observed in 5-10% of affected individuals.

Auditory deficits are commonly observed in Stickler syndrome. The hearing loss may be either conductive or sensorineural or mixed in nature [2]. It is often more severe and progressive in type II Stickler syndrome. Other otologic problems include chronic otitis media, glue ear and increased mobility of the bones of the middle ear.

Affected patients may also suffer from a multitude of cranio-facial abnormalities, with the face appearing flattened due to a small and flat nose, long philtrum, large eyes and hypoplastic bones. Some may present with the Pierre-Robin sequence, a group of cranial malformations comprising of a cleft palate, glossoptosis, micrognathia and a bifid uvula. Children may have difficulties in breathing and feeding due to these defects. Malocclusion of the upper/ lower teeth is also seen in a few individuals.

Amongst the musculoskeletal complaints usually seen, painful, stiff joints with early osteoarthritis is a common finding. Abnormally lax joints leading to dislocations are seen early in the course of the disease. Other frequent findings include: spinal deformities such as kyphosis, scoliosis, spondylolisthesis [3]; chest malformations in the form of pectus carinatum and excavatum; and limb anomalies such as arachnodactyly, pes planus, hypotonia and Legg-Calve-Perthes disease.

Learning disabilities and mitral valve prolapse have also been observed in a few individuals [4].

• Pathologist

  Audiologists and speech-language pathologists should be familiar with the characteristics associated with Stickler syndrome to facilitate early identification and appropriate management. [ncbi.nlm.nih.gov]

  […] are likely to be involved in the treatment of those with Stickler's syndrome, include anesthesiologists, oral and maxillofacial surgeons ; craniofacial surgeons; ear, nose, and throat specialists, ophthalmologists, optometrists, audiologists, speech pathologists [en.wikipedia.org]

• Dysphagia

  […] lipodystrophy associated with PPARG mutations Saul Wilkes Stevenson syndrome Cartilage-hair hypoplasia Nguyen syndrome Glanzmann thrombasthenia Jacobsen syndrome 6-pyruvoyl-tetrahydropterin synthase deficiency Charcot-Marie-Tooth disease type 2B Odontoma dysphagia [checkrare.com]

• Mitral Valve Prolapse

  The prevalence of mitral valve prolapse in Stickler syndrome has been reported to be much higher than in the general population. [ncbi.nlm.nih.gov]

  About half of those with Stickler syndrome have a heart defect called mitral valve prolapse. [health.ucdavis.edu]

  Scoliosis Mitral Valve Prolapse (45-50%) - occurs when the heart valve shuts and then protrudes into the next chamber. [en.wikibooks.org]

  More than 50% of patients affected with this condition have a mitral valve prolapse and authors have suggested that in the presence of an autosomal dominant inherited mitral valve prolapse, a Stickler syndrome should be suspected until proven otherwise [accessanesthesiology.mhmedical.com]

• Hypertension

  Vitreous assessment is the diagnostic criteria [2] and guides to molecular genetic analysis. [3] Complications such as RD (70%), cataract (49%), and ocular hypertension (10%) [4] are progressive and can lead to blindness. [ijo.in]

  People with eye involvement are prone to increased pressure within the eye ( ocular hypertension ) which could lead to glaucoma and tearing or detachment of the light-sensitive retina of the eye ( retinal detachment ). [en.wikipedia.org]

  SNHL 20 dB N/T Height: 1.58 m Diabetes mellitus, hypertension 1/II-1 43 y R507X/R507X 0.6/0.5 −6.25/−8.00 (24 y)† Cataract extraction (32 y), axial length 25 mm‡, vitreous membranes; VR adhesions; paravascular retinal degeneration, retinoschisis; Goldmann [iovs.arvojournals.org]

  Cardiovascular findings such as benign murmurs, pulmonary stenosis, patent ductus arteriosus, patent foramen ovale, atrial septal defect, and pulmonary hypertension have all been documented. Their prevalence varies in the literature from 5-58%. [emedicine.medscape.com]

  […] dysplasia x-linked with mental deterioration Limb-girdle muscular dystrophy Palmoplantar keratoderma-sclerodactyly syndrome Limb-body wall complex Lopes Gorlin syndrome Currarino triad Spondylometaphyseal dysplasia with cone-rod dystrophy Brachydactyly with hypertension [checkrare.com]

• Macroglossia

  Pierre Robin sequence includes an opening in the roof of the mouth (a cleft palate), a large tongue (macroglossia), and a small lower jaw (micrognathia). Bones are affected by slight platyspondylisis and large, often defective epiphyses. [malacards.org]

  Systemic findings may include micrognathia and macroglossia resulting in cleft palate (Pierre-Robin sequence: an unusually small mandible (micrognathia), posterior displacement or retraction of the tongue (glossoptosis), upper airway obstruction, and [eyewiki.aao.org]

• Prolapse

  The prevalence of mitral valve prolapse in Stickler syndrome has been reported to be much higher than in the general population. [ncbi.nlm.nih.gov]

  About half of those with Stickler syndrome have a heart defect called mitral valve prolapse. [health.ucdavis.edu]

  Scoliosis Mitral Valve Prolapse (45-50%) - occurs when the heart valve shuts and then protrudes into the next chamber. [en.wikibooks.org]

  More than 50% of patients affected with this condition have a mitral valve prolapse and authors have suggested that in the presence of an autosomal dominant inherited mitral valve prolapse, a Stickler syndrome should be suspected until proven otherwise [accessanesthesiology.mhmedical.com]

• Photophobia

  Protein-Associated Neurodegeneration Spondylometaphyseal dysplasia, Kozlowski type Hereditary neuralgic amyotrophy Elastosis perforans serpiginosa Yunis-Varon syndrome Beta-Propeller Protein-Associated Neurodegeneration Ichthyosis follicularis atrichia photophobia [checkrare.com]

• Lacrimation

  Brachydactyly Mononen type Kniest like dysplasia lethal Pierson syndrome Retinal arterial macroaneurysm with supravalvular pulmonic stenosis Vascular hyalinosis Lujan syndrome Hydrocephalus obesity hypogonadism Tetraamelia with ectodermal dysplasia and lacrimal [checkrare.com]

• Hearing Impairment

  Stapedial fixation can be the cause of hearing impairment in Stickler syndrome type I (COL2A1). The hearing impairment can be improved by stapes surgery. [ncbi.nlm.nih.gov]

• Arthritis

  People with the syndrome may develop arthritis -like symptoms as adults along with progressive spine problems and back pain. [medicinenet.com]

  Severe myopia leading to blindness, cleft palate, or subnucous cleft, Pierre Robin anomaly, premature degenerative arthritis, or a family history of any of these indicates further evaluation. [ncbi.nlm.nih.gov]

• Back Pain

  Thoracolumbar radiographs were analyzed for spinal abnormalities and correlation with age and back pain. [ncbi.nlm.nih.gov]

  People with the syndrome may develop arthritis -like symptoms as adults along with progressive spine problems and back pain. [medicinenet.com]

  Children complain of repeated back pain due to misalignment of the spine. Depression or prominence of the chest bone may be present. [medindia.net]

• Myopathy

  Primary Sidebar Congenital and Genetic Diseases Norrie disease Spinocerebellar ataxia 8 Supernumerary nipple Hereditary sensory and autonomic neuropathy type 7 Ehlers-Danlos syndrome, cardiac valvular type Welander distal myopathy, Swedish type Acromesomelic [checkrare.com]

  […] dysplasia congenita Spondyloepimetaphyseal dysplasia, Strudwick type Kniest dysplasia (see also C2/11 ) COL3 : Ehlers–Danlos syndrome, types 3 & 4 Sack–Barabas syndrome COL4 : Alport syndrome COL5 : Ehlers–Danlos syndrome, types 1 & 2 COL6 : Bethlem myopathy [en.wikipedia.org]

• Low Back Pain

  Osteoarthritis (75% of patients) with onset before 30 years of age is a severe manifestation that causes chronic hip and low back pain and functional impairments. Joint replacement surgery is often required. [ncbi.nlm.nih.gov]

• Severe Short Stature

  Several short stature conditions are caused by COL2A1. These include achondrogenesis type 2, hypochondrogenesis, Kniest dysplasia and spondyloepimetaphyseal dysplasia, Strudwick type. Two short-stature conditions are also caused by COL11A2 changes. [dbproject.mn.org]

The diagnosis of Stickler syndrome is based on a combination of clinical findings, family history and genetic data. Diagnostic criteria, although proposed, have yet to reach a majority consensus [5].

Amongst the various clinical features, vitreo- retinal changes, sensorineural hearing loss and cleft palate are considered major manifestations (2 points each). Other auditory deficits and skeletal features make up the minor findings (1 point each). A diseased first-degree relative with autosomal dominant inheritance also aids in the diagnosis of Stickler syndrome. Criterion adding up to or greater than 5 points makes the individual more susceptible to this syndrome. The absence of an alternate diagnosis lends more weight to these findings.

The syndrome is however, confirmed by genetic studies demonstrating pathologic variants in the following six genes: COL2A1, COL11A1, COL11A2, COL9A1, COL9A2, or COL9A3 [6] [7] [8] [9] [10]. Serial single or multi-gene panels may be used to evaluate the mutations present in such genes.

Individual patient matching protocols purposely weighted bias against the effectiveness of treatment. All treatment side effects are reported. MAIN OUTCOME MEASURES: Time to retinal detachment and side effects occurring after prophylactic treatment. [ncbi.nlm.nih.gov]

(3% incidence of RD) as compared to no treatment (73% incidence of RD). [eyewiki.aao.org]

Management and Treatment How is Stickler syndrome treated? Treatment for Stickler syndrome varies depending on a person’s symptoms. There’s no cure for the condition, so treatment aims to alleviate symptoms. [my.clevelandclinic.org]

As PRS is aetiologically heterogeneous, the prognosis depends on the cause. Genetic investigations and familial history must be taken into account. [ncbi.nlm.nih.gov]

Prognosis There is currently no available data on long-term visual prognosis of Stickler syndrome; however, prophylactic treatment to prevent retinal detachment is expected to improve long term visual prognosis. [eyewiki.aao.org]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Primary Etiologies of Deaf-Blindness – Alphabetically Rarelink. Pohjoismainen linkkikokoelma ja yhteydenpitomahdollisuudet harvinaisia sairauksia sairastaville [kuurosokeat.fi]

Etiology and Pathogenesis Frequency This heterogeneous birth defect has a prevalence of approximately 1 per 8500 live births. The male-to-female ratio is 1:1, except in the X-linked form. Etiology Autosomal recessive inheritance is possible. [emedicine.medscape.com]

Pierre Robin sequence in Denmark: a retrospective population-based epidemiological study. Cleft Palate Craniofac J. 2004;41:47–52. Robin NH et al. Stickler Syndrome. GeneReviews® 2000 June 9 (Updated 2014 Nov 26) [asperbio.com]

The discussion covers the phenotype spectrum, epidemiology, mode of inheritance, pathogenesis, and clinical profile of each condition, all of which is accompanied by a wealth of illustrations. [books.google.com]

Epidemiology of retinal detachment. ( 25817961 ) Vilaplana F....Mojal S. 2015 37 Giant premacular bursa: a novel finding of the posterior vitreous in two patients with Stickler syndrome type 1 revealed by swept-source optical coherence tomography. ( 26245341 [malacards.org]

An inherited translocation defect has been identified in one Pierre Robin family. [ 3 ] Candidate genes and loci are under investigation. [ 4 ] Epidemiology Incidence PRS is a rare condition. [patient.info]

Epidemiology [ edit ] In the US, the estimated prevalence of Stickler syndrome is about 1 in 10,000 people, but it can affect as few as 1 in 100,000 in other areas of the world. [ citation needed ] History [ edit ] Scientists associated with the discovery [en.wikipedia.org]

This finding will have a major impact on the genetic counseling of patients with Stickler syndrome and on the understanding of the pathophysiology of collagens. [ncbi.nlm.nih.gov]

The pathophysiology of the spinal abnormalities in Stickler syndrome has not been fully defined. [medsci.org]

Pathophysiology Stickler syndrome is believed to be a direct result of abnormalities in the production of collagen types II, IX and XI, all of which are recognized as components of the human vitreous. [2] Normal collagen fibrils are composed of three [eyewiki.aao.org]

Together with molecular data, ophthalmologists should consider genetic diagnosis of Stickler syndrome in patients with vitreous anomaly to prevent blindness from retinal detachment. [ncbi.nlm.nih.gov]

Stiff, sore joints prevented me from keeping up with my peers, extreme short-sightedness prevented me from seeing the blackboard, and my hearing was intermittent. [clapa.com]

You can’t prevent Stickler syndrome since it’s the result of an inherited genetic mutation. [my.clevelandclinic.org]

[…] three-dimensional ultrasound and three-dimensional helical computer tomography in the prenatal diagnosis of Stickler Syndrome. ( 30251283 ) Gueneuc A...Ville Y 2018 15 The importance of early diagnosis of Stickler syndrome: Finding opportunities for preventing [malacards.org]

Prevention Stickler syndrome is an inherited condition and cannot be prevented. Genetic screening can help affected adults assess disease risk to their offspring. Early diagnosis and treatment is key to preventing serious complications. [innerbody.com]

1. Vu CD, Brown J, Körkkö J, Ritter R, Edwards AO. Posterior chorioretinal atrophy and vitreous phenotype in a family with Stickler syndrome from a mutation in the COL2A1 gene. Ophthalmology. 2003;110(1):70-7.
2. Snead MP, Yates JR. Clinical and Molecular genetics of Stickler syndrome. J Med Genet. 1999;36:353–9.
3. Rose PS, Ahn NU, Levy HP, et al. Thoracolumbar spinal abnormalities in Stickler syndrome. Spine. 2001;26(4):403-9.
4. Liberfarb RM, Goldblatt A. Prevalence of mitral-valve prolapse in the Stickler syndrome. Am J Med Genet. 1986;24(3):387-92.
5. Rose PS, Levy HP, Liberfarb RM, et al. Stickler syndrome: clinical characteristics and diagnostic criteria. Am J Med Genet A. 2005;138A(3):199-207.
6. Stickler GB, Belau PG, Farrell FJ, et al. Hereditary progressive arthro-ophthalmopathy. Mayo Clin Proc. 1965;40:433-55.
7. Parentin F, Sangalli A, Mottes M, Perissutti P. Stickler syndrome and vitreoretinal degeneration: correlation between locus mutation and vitreous phenotype. Apropos of a case. Graefes Arch Clin Exp Ophthalmol. 2001;239(4):316-9.
8. Van camp G, Snoeckx RL, Hilgert N, et al. A new autosomal recessive form of Stickler syndrome is caused by a mutation in the COL9A1 gene. Am J Hum Genet. 2006;79(3):449-57.
9. Baker S, Booth C, Fillman C, et al. A loss of function mutation in the COL9A2 gene causes autosomal recessive Stickler syndrome. Am J Med Genet A. 2011;155A(7):1668-72.
10. Faletra F, D'adamo AP, Bruno I, et al. Autosomal recessive Stickler syndrome due to a loss of function mutation in the COL9A3 gene. Am J Med Genet A. 2014;164A(1):42-7.