Reply to: Intellectual impairment is not commonly a feature of Turner syndrome

We thank Dr Dixon for her comments on Turner syndrome.

As she has correctly pointed out, the main features are specific learning difficulties and some difficulties in social development. Only a small subset of Turner syndrome (tiny ring X chromosome) have significant intellectual impairment. ¹ With limited space and word restriction, these were ‘loosely’ grouped under our heading of ‘intellectual impairment’ in Table 2 of our review. ²

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Table 2.

Syndromes associated with strabismus and their clinical features, amended from Chua et al. ²

Syndrome	Clinical features
Apert syndrome20,95	Brachycephaly Craniosynostosis Midface hypoplasia Cervical spinal fusion Obstructive sleep apnoea Multidigit hand and foot syndactyly Congenital cardiac defects Intellectual disability
Cri du chat syndrome21	Laryngeal abnormalities Micrognathia Mental disability Hypotonia Congenital cardiac defects Prone to hypothermia
Crouzon syndrome	Premature fusion of skull Midface hypoplasia C2–3 fusion CVS abnormalities (patent ductus arteriosus, coarctation of aorta) Intellectual disability
Down syndrome23	Congenital cardiac defects Pulmonary hypertension C1–2 subluxation Subglottic stenosis Intellectual impairment Obesity
Goldenhar syndrome24	Hemifacial microsomia Vertebral anomalies CNS malformation Congenital cardiac defects
Marfan syndrome25	High arched palate C1/2 instability Temporomandibular joint laxity Spontaneous pneumothorax Cardiovascular involvement (valvular disease, aortic dissection, cardiac conduction defects)
Moebius syndrome26	Orofacial abnormalities Skeletal hypotonia Increased oral secretion Gastrointestinal reflux Congenital cardiac defects Spinal anomalies
Stickler syndrome27	Midface hypoplasia Micrognathia Scoliosis
Turner syndrome28	Small mandible High arched palate Congenital cardiac defects Intellectual disability (severe cases only)

CNS: central nervous system; CVS: cardiovascular system.

The references numbers shown in the table refer to the original review article reference list.

The focus of our review article was on anaesthetic considerations for strabismus surgery. The purpose of the table on the syndromes was to provide readers with some information on each of the strabismus-associated syndromes, as some of these syndromes are rare. The table was not meant to be comprehensive or exhaustive of all the features of each syndrome; therefore, many clinical features were not listed.

A version of Table 2, amended as per Dr Dixon’s comments, is included here.