Congenital Anomolies - Lid Disorders

• Cryptophthalmos
  
  • A rare failure of lid differentiation
  • Skin over eye (no lids or palpebral fissure) that sometimes blends in with the cornea which is usually malformed.
• Congenital Coloboma
  • Often well tolerated
    • no keratopathy
  • Involves primarily the upper lid
• Ankyloblepharon
  • Fusion of part or all lid margin: variant: Ankyloblepharon filiforme adnatum in which the lid margins are connected by fine strands.
• Congenital Entropion
  • Usually involves the lower lid
  • Distal part of tarsus rotated inward
  • Lashes abrade the cornea causing keratopathy
  • Permanent corneal damage is uncommon
• Epiblepharon
  • A horizontal fold of skin adjacent to either the upper or lower lid
    • More commonly the lower lid
  • Tolerated well by the cornea
  • Often spontaneously resolves in the first years of life
  • Surgery only indicated for severe cases
• Congenital Tarsal Kink
  • Child is born with the upper lid bent backwards often with a 180 degree fold in the upper tarsal plate
  • Corneal exposure and rubbing by the bent edge can result in ulceration
• Distichiasis
  • An accessory row of lashes growing from the meibomian orifices or posteriorly
  • The lashes are thinner, shorter, less pigmented and frequently well tolerated
• Euryblepharon
  • Enlargement of the lateral part of the palpebral aperture with downward displacement of the temporal 1/2 of the lower lid.
• Epicanthus
  • Crescentic fold of skin running vertically between the lids and overlying the inner canthus. There are three types:
    1. Inversus: If the fold is most prominent in the lower eyelid
    2. Tarsalis: (Most people) The fold is most prominent in the upper eyelid
    3. Palpebralis: If the fold is equally distributed in the upper and lower eyelids.
• Telecanthus
  • Normal interpupillary distance but wide intercanthal distance
    i.e. Waardenburg's syndrome
  • not: Hypertelorism, which indicates increased distance between the
    bony orbits.

• Blepharophimosis

  • Vertically and horizontally shortened Syndrome palpebral fissures
  • Epicanthus inversus
  • Telecanthus
  • Ptosis: with poor levator function and no lid fold
  • When should the Ptosis be repaired?
    • Frontalis slings are usually done early in life
    • Repairing telecanthus and epicanthus which may improve with age is delaye