Mucopolysaccharidosis type I (MPSI) is caused by deficient alpha-iduronidase enzyme activity, which results in an accumulation of the glycoamnioglycan heparan sulfate and dermatan sulfate in body tissues. MPS I is a multisystem progressive disorder demonstrating wide phenotypic variability with three different MPSI subtypes described (Hurler, Hurler-Scheie, and Scheie). Hurler syndrome is considered the more severe end of the phenotypic spectrum with patients generally diagnosed before 18 months of age while Hurler-Scheie and Scheie syndromes are usually used to describe the milder phenotypes. These less severe cases, also known as attenuated MPS I, will often present between 3 and 10 years of age. Clinical features of MPS I include coarse facial features, dysostosis multiplex, short stature, hirsutism, cloudy corneas, and hepatosplenomegaly, and cardiac comlications. Developmental delay and intellectual disability is more severe in those patients with Hurler syndrome and is a distinguishing feature between the subtypes of MPS I.