The ophthalmic findings in Cohen syndrome

Abstract

Aim: Cohen syndrome is an uncommon autosomal recessive condition comprising a characteristic facial appearance, mental retardation, benign neutropenia, and retinal dystrophy. This study aimed to identify patients with Cohen syndrome from across the United Kingdom in order to define the variability of ophthalmic manifestations.

Methods: Ophthalmic assessment was undertaken and past ophthalmic records reviewed in 22 patients with classic features of Cohen syndrome.

Results: All patients had visual problems which commonly started in the preschool years. 82% developed strabismus or refractive error during the first 5 years of life. 70% developed high myopia by the second decade. By contrast with the findings of others, early onset retinal dystrophy was common, occurring in 80% of study patients under age 5 years. 35% of patients were registered partially sighted or blind.

Conclusion: The ophthalmic abnormalities associated with Cohen syndrome, including high myopia and a generalised, severe retinal dystrophy, are of early onset and frequently result in severe visual handicap. Cohen syndrome should be considered in the young, developmentally delayed child who presents with severe myopia and nyctalopia.

Figure 1

(A, B) Two patients, aged 4 and 19 years, with Cohen syndrome illustrating the characteristic facial appearance. Note the short philtrum, prominent incisors, and grimace-like appearance on smiling. (C) Bilateral incomplete inferior coloboma and pigmentary retinopathy in a young man with Cohen syndrome, (patient 17). (D) Pigmentary retinopathy typically seen in Cohen syndrome: note bone spicule changes in the lower retina.