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Brittle cornea syndrome 1(BCS1)

MedGen UID:
78661
Concept ID:
C0268344
Disease or Syndrome
Synonyms: BCS1; Corneal fragility keratoglobus, blue sclerae AND joint hypermobility; Corneal fragility, keratoglobus, blue sclerae, joint hyperextensibility; DYSGENESIS MESODERMALIS CORNEAE ET SCLERAE; EDS VIB (formerly); EDS6B; Ehlers-Danlos syndrome type 6B (formerly); Fragilitas oculi with joint hyperextensibility
SNOMED CT: Brittle cornea syndrome (719096006); Ehlers-Danlos syndrome type 6B (719096006)
 
Gene (location): ZNF469 (16q24.2)
 
Monarch Initiative: MONDO:0024543
OMIM®: 229200

Definition

Brittle cornea syndrome (BCS) is characterized by blue sclerae, corneal rupture after minor trauma, keratoconus or keratoglobus, hyperelasticity of the skin, and hypermobility of the joints (Al-Hussain et al., 2004). It is classified as a form of Ehlers-Danlos syndrome (Malfait et al., 2017). Genetic Heterogeneity of Brittle Cornea Syndrome Brittle cornea syndrome-2 (BCS2; 614170) is caused by mutation in the PRDM5 gene (614161) on chromosome 4q27. [from OMIM]

Clinical features

From HPO
Mitral valve prolapse
MedGen UID:
7671
Concept ID:
C0026267
Disease or Syndrome
One or both of the leaflets (cusps) of the mitral valve bulges back into the left atrium upon contraction of the left ventricle.
Disproportionate tall stature
MedGen UID:
323048
Concept ID:
C1836996
Finding
A tall and slim body build with increased arm span to height ratio (>1.05) and a reduced upper-to-lower segment ratio (<0.85), i.e., unusually long arms and legs. The extremities as well as the hands and feet are unusually slim.
Hearing impairment
MedGen UID:
235586
Concept ID:
C1384666
Disease or Syndrome
A decreased magnitude of the sensory perception of sound.
Dentinogenesis imperfecta
MedGen UID:
8313
Concept ID:
C0011436
Congenital Abnormality
Developmental dysplasia of dentin.
Congenital hip dislocation
MedGen UID:
9258
Concept ID:
C0019555
Disease or Syndrome
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Spondylolisthesis
MedGen UID:
52470
Concept ID:
C0038016
Disease or Syndrome
Spondylolisthesis is defined as forward slipping of a vertebral body on the one below it. Spondylolysis is defined as a defect in the pars interarticularis without vertebral slipping (summary by Wiltse et al., 1975).
Joint hypermobility
MedGen UID:
336793
Concept ID:
C1844820
Finding
The capability that a joint (or a group of joints) has to move, passively and/or actively, beyond normal limits along physiological axes.
Macrocephaly
MedGen UID:
745757
Concept ID:
C2243051
Finding
Occipitofrontal (head) circumference greater than 97th centile compared to appropriate, age matched, sex-matched normal standards. Alternatively, a apparently increased size of the cranium.
Atypical scarring of skin
MedGen UID:
867415
Concept ID:
C4021786
Pathologic Function
Atypically scarred skin .
Epicanthus
MedGen UID:
151862
Concept ID:
C0678230
Congenital Abnormality
Epicanthus is a condition in which a fold of skin stretches from the upper to the lower eyelid, partially covering the inner canthus. Usher (1935) noted that epicanthus is a normal finding in the fetus of all races. Epicanthus also occurs in association with hereditary ptosis (110100).
Red hair
MedGen UID:
66796
Concept ID:
C0239803
Finding
Molluscoid pseudotumors
MedGen UID:
375465
Concept ID:
C1844597
Disease or Syndrome
Bluish-grey, spongy nodules associated with scars over pressure points and easily traumatized areas like the elbows and knees.
Palmoplantar cutis laxa
MedGen UID:
341602
Concept ID:
C1856714
Finding
Loose, wrinkled skin of hands and feet.
Keratoconus
MedGen UID:
44015
Concept ID:
C0022578
Disease or Syndrome
A cone-shaped deformity of the cornea characterized by the presence of corneal distortion secondary to thinning of the apex.
Myopia
MedGen UID:
44558
Concept ID:
C0027092
Disease or Syndrome
Nearsightedness, also known as myopia, is an eye condition that causes blurry distance vision. People who are nearsighted have more trouble seeing things that are far away (such as when driving) than things that are close up (such as when reading or using a computer). If it is not treated with corrective lenses or surgery, nearsightedness can lead to squinting, eyestrain, headaches, and significant visual impairment.\n\nNearsightedness usually begins in childhood or adolescence. It tends to worsen with age until adulthood, when it may stop getting worse (stabilize). In some people, nearsightedness improves in later adulthood.\n\nFor normal vision, light passes through the clear cornea at the front of the eye and is focused by the lens onto the surface of the retina, which is the lining of the back of the eye that contains light-sensing cells. People who are nearsighted typically have eyeballs that are too long from front to back. As a result, light entering the eye is focused too far forward, in front of the retina instead of on its surface. It is this change that causes distant objects to appear blurry. The longer the eyeball is, the farther forward light rays will be focused and the more severely nearsighted a person will be.\n\nNearsightedness is measured by how powerful a lens must be to correct it. The standard unit of lens power is called a diopter. Negative (minus) powered lenses are used to correct nearsightedness. The more severe a person's nearsightedness, the larger the number of diopters required for correction. In an individual with nearsightedness, one eye may be more nearsighted than the other.\n\nEye doctors often refer to nearsightedness less than -5 or -6 diopters as "common myopia." Nearsightedness of -6 diopters or more is commonly called "high myopia." This distinction is important because high myopia increases a person's risk of developing other eye problems that can lead to permanent vision loss or blindness. These problems include tearing and detachment of the retina, clouding of the lens (cataract), and an eye disease called glaucoma that is usually related to increased pressure within the eye. The risk of these other eye problems increases with the severity of the nearsightedness. The term "pathological myopia" is used to describe cases in which high myopia leads to tissue damage within the eye.
Blue sclerae
MedGen UID:
154236
Concept ID:
C0542514
Finding
An abnormal bluish coloration of the sclera.
Decreased corneal thickness
MedGen UID:
473349
Concept ID:
C1096274
Finding
A decreased anteroposterior thickness of the cornea.
Abnormal cornea morphology
MedGen UID:
383737
Concept ID:
C1855670
Finding
Any abnormality of the cornea, which is the transparent tissue at the front of the eye that covers the iris, pupil, and anterior chamber.
Visual loss
MedGen UID:
784038
Concept ID:
C3665386
Finding
Loss of visual acuity (implying that vision was better at a certain time point in life). Otherwise the term reduced visual acuity should be used (or a subclass of that).
Keratoglobus
MedGen UID:
854390
Concept ID:
C3887531
Anatomical Abnormality
Limbus-to-limbus corneal thinning, often greatest in the periphery, with globular protrusion of the cornea.

Professional guidelines

PubMed

Burkitt Wright EM, Porter LF, Spencer HL, Clayton-Smith J, Au L, Munier FL, Smithson S, Suri M, Rohrbach M, Manson FD, Black GC
Orphanet J Rare Dis 2013 May 4;8:68. doi: 10.1186/1750-1172-8-68. PMID: 23642083Free PMC Article

Recent clinical studies

Etiology

Moore P, Wolf A, Sathyamoorthy M
Int J Mol Sci 2024 May 28;25(11) doi: 10.3390/ijms25115848. PMID: 38892036Free PMC Article
Porter LF, Gallego-Pinazo R, Keeling CL, Kamieniorz M, Zoppi N, Colombi M, Giunta C, Bonshek R, Manson FD, Black GC
Orphanet J Rare Dis 2015 Nov 11;10:145. doi: 10.1186/s13023-015-0360-4. PMID: 26560304Free PMC Article
Davidson AE, Borasio E, Liskova P, Khan AO, Hassan H, Cheetham ME, Plagnol V, Alkuraya FS, Tuft SJ, Hardcastle AJ
Invest Ophthalmol Vis Sci 2015 Jan 6;56(1):578-86. doi: 10.1167/iovs.14-15792. PMID: 25564447
Burkitt Wright EM, Porter LF, Spencer HL, Clayton-Smith J, Au L, Munier FL, Smithson S, Suri M, Rohrbach M, Manson FD, Black GC
Orphanet J Rare Dis 2013 May 4;8:68. doi: 10.1186/1750-1172-8-68. PMID: 23642083Free PMC Article
Burkitt Wright EMM, Spencer HL, Daly SB, Manson FDC, Zeef LAH, Urquhart J, Zoppi N, Bonshek R, Tosounidis I, Mohan M, Madden C, Dodds A, Chandler KE, Banka S, Au L, Clayton-Smith J, Khan N, Biesecker LG, Wilson M, Rohrbach M, Colombi M, Giunta C, Black GCM
Am J Hum Genet 2011 Jun 10;88(6):767-777. doi: 10.1016/j.ajhg.2011.05.007. PMID: 21664999Free PMC Article

Diagnosis

Incandela C, D'Oria F, Lapenna L, Acquaviva A
Eur J Ophthalmol 2024 Jan;34(1):11-17. Epub 2023 Apr 18 doi: 10.1177/11206721231171426. PMID: 37073081
Wang H, Zhang X, Gao X, Li W
BMC Ophthalmol 2023 Sep 15;23(1):378. doi: 10.1186/s12886-023-03123-9. PMID: 37710225Free PMC Article
García de Oteyza G, Fernández Engroba J, Charoenrook V
Cornea 2023 Jul 1;42(7):894-898. Epub 2023 Apr 24 doi: 10.1097/ICO.0000000000003280. PMID: 37098112
Mandlik K, Betdur RA, Rashmita R, Narayana S
Indian J Ophthalmol 2022 Jul;70(7):2594-2597. doi: 10.4103/ijo.IJO_2894_21. PMID: 35791165Free PMC Article
Burkitt Wright EM, Porter LF, Spencer HL, Clayton-Smith J, Au L, Munier FL, Smithson S, Suri M, Rohrbach M, Manson FD, Black GC
Orphanet J Rare Dis 2013 May 4;8:68. doi: 10.1186/1750-1172-8-68. PMID: 23642083Free PMC Article

Therapy

Kaufmann C, Schubiger G, Thiel MA
Cornea 2015 Oct;34(10):1326-8. doi: 10.1097/ICO.0000000000000577. PMID: 26266434
Ioscovich A, Grisaru-Granovsky S, Halpern S, Shapiro Y
Arch Gynecol Obstet 2011 Mar;283 Suppl 1:49-52. Epub 2011 Jan 22 doi: 10.1007/s00404-011-1838-5. PMID: 21258811

Prognosis

Arce-González R, Chacon-Camacho OF, Ordoñez-Labastida V, Graue-Hernandez EO, Navas-Pérez A, Zenteno JC
Int Ophthalmol 2023 Mar;43(3):807-815. Epub 2022 Sep 1 doi: 10.1007/s10792-022-02481-5. PMID: 36048286
Bouhouche A, Albaroudi N, El Alaoui MA, Askander O, Habbadi Z, El Hassani A, Iraqi H, El Fahime E, Belmekki M
Exp Eye Res 2021 Aug;209:108671. Epub 2021 Jun 13 doi: 10.1016/j.exer.2021.108671. PMID: 34133966
Kaufmann C, Schubiger G, Thiel MA
Cornea 2015 Oct;34(10):1326-8. doi: 10.1097/ICO.0000000000000577. PMID: 26266434
Davidson AE, Borasio E, Liskova P, Khan AO, Hassan H, Cheetham ME, Plagnol V, Alkuraya FS, Tuft SJ, Hardcastle AJ
Invest Ophthalmol Vis Sci 2015 Jan 6;56(1):578-86. doi: 10.1167/iovs.14-15792. PMID: 25564447

Clinical prediction guides

Sklar BA, Pisuchpen P, Bareket M, Milman T, Eagle RC Jr, Minor J, Procopio R, Capasso J, Levin AV, Hammersmith K
Cornea 2023 Dec 1;42(12):1572-1577. Epub 2023 Sep 15 doi: 10.1097/ICO.0000000000003372. PMID: 37713669
Arce-González R, Chacon-Camacho OF, Ordoñez-Labastida V, Graue-Hernandez EO, Navas-Pérez A, Zenteno JC
Int Ophthalmol 2023 Mar;43(3):807-815. Epub 2022 Sep 1 doi: 10.1007/s10792-022-02481-5. PMID: 36048286
Wan Q, Tang J, Han Y, Xiao Q, Deng Y
BMC Ophthalmol 2018 Sep 18;18(1):252. doi: 10.1186/s12886-018-0903-2. PMID: 30227830Free PMC Article
Porter LF, Gallego-Pinazo R, Keeling CL, Kamieniorz M, Zoppi N, Colombi M, Giunta C, Bonshek R, Manson FD, Black GC
Orphanet J Rare Dis 2015 Nov 11;10:145. doi: 10.1186/s13023-015-0360-4. PMID: 26560304Free PMC Article
Davidson AE, Borasio E, Liskova P, Khan AO, Hassan H, Cheetham ME, Plagnol V, Alkuraya FS, Tuft SJ, Hardcastle AJ
Invest Ophthalmol Vis Sci 2015 Jan 6;56(1):578-86. doi: 10.1167/iovs.14-15792. PMID: 25564447

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