Orbicularis muscle fixation downward for the correction of congenital epiblepharon in Chinese patients

BACKGROUND

Congenital epiblepharon (CE) is a congenital eyelid deformity unique to young individuals of Asian descendants, and it might cause a sequence of other complications such as corneal damage and ocular foreign body sensation. Surgery is the most effective approach to treat this condition. Here, this study evaluated the effectiveness and safety of the orbicularis muscle fixation downward (OMFD) procedure for correcting CE.

METHODS

This study enrolled 29 patients who were diagnosed with CE. These patients experienced significant ocular irritation leading to epiphora and corneal injury and, therefore, they underwent the OMFD procedure that was performed by the same surgeon. The cases were divided into 3 grades according to postoperative outcomes.

RESULTS

The OMFD procedure was performed on 55 lower lids of the 29 patients. The average age of the patients was 9.6 years. The mean follow-up duration was 17 months. No perioperative complications were observed, and successful surgical outcomes were achieved in all 29 patients. No postoperative necrosis, infection, or corneal epithelial injury occurred. None of the patients exhibited significant scarring. Three patients showed residual 1-3 eyelashes touching the nasal corneal or bulbar conjunctiva at the inner canthus during the last postoperative examination. These patients did not undergo further surgery as there were no obvious irritation symptoms or corneal damage.

CONCLUSIONS

The fixation of the pretarsal orbicularis muscle is a simple and effective modification of the Hotz procedure to correct CE. The key aspect of this procedure is the suturing of the pretarsal orbicularis muscle and the lower eyelid retractors.

Thyroid Eye Disease-Related Epiblepharon: A Comparative Case Study

PURPOSE

This study describes the clinical features and management of epiblepharon as a manifestation of thyroid eye disease (TED). In addition, we compare the frequency and age in Asian and non-Asian patients, and discuss pathophysiologic implications.

DESIGN

Retrospective case-control study.

METHODS

This is a single-center retrospective review that identified 172 adult patients (age 19 to 83) with TED that were consecutively evaluated by 1 author (T.J.M.) between December 2015 and July 2018. Diagnosis of TED and epiblepharon was based upon clinical assessment as documented in the medical record.

RESULTS

In a cohort of 172 patients (mean age 52; 138 female), 3 patients with acquired epiblepharon were identified, all of whom were Asian. The proportion of affected Asian patients (3/of 17, 17.6%) was significantly higher than that of non-Asian patients (0/155, P < 0.001). Patients with epiblepharon were also significantly younger than those without epiblepharon, 29.7 ± 2.1 versus 48.7 ± 13 years of age (P = 0.026). All 3 patients underwent surgical correction with lateral canthoplasty and anterior lamellar pretarsal fixation with successful outcomes.

CONCLUSIONS

Lower eyelid epiblepharon may occur in TED. In our clinic-based population, this finding was significantly more frequent in Asian patients and in younger patients. Relieving horizontal tension in conjunction with anterior lamella pretarsal fixation is an effective method of correcting TED-associated epiblepharon.

Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2years of age

INTRODUCTION

Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes.

OBJECTIVE

Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle.

MATERIAL AND METHODS

Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A.

RESULTS

A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months).

CONCLUSIONS

The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age.

Sex-specific difference in age distribution of congenital lower eyelid epiblepharon in a Japanese population

PURPOSE

To examine the sex-specific differences in age distribution of Japanese patients with congenital lower eyelid epiblepharon.

STUDY DESIGN

A retrospective, observational study.

METHODS

A total of 291 patients (87 men, 204 women) who underwent modified Hotz for correction of congenital lower eyelid epiblepharon were included in this study. Data on sex, age at surgical intervention, and affected side were collected. Patients' age was classified according to the orbital growth pattern (0-3 years, 4-6 years, 7-12 years, 13-15 years, and ≥ 16 years). The sex-specific difference in age distribution was analysed using Pearson's chi-squared test.

RESULTS

Among male patients, 75 (86.2%) underwent surgery during 4-12 years of age. Only 2 (2.3%) boys had surgery at 13-15 years and 1 had it while he was ≥ 16 years. Among female patients, 11 (5.4%) underwent surgery at 13-15 years and 59 (28.9%) at ≥ 16 years. The age distribution was significantly different between sexes (P < 0.001).

CONCLUSION

Among patients aged ≥13 years, there were more women compared to men. This implies that congenital lower eyelid epiblepharon is more persistent in females and may reflect slower and less orbital growth from 13 years of age and onwards in females. The results suggest that as long as there are no severe corneal complications and no risk for amblyopia, conservative management may be a good option for males since spontaneous resolution is likely to occur. However, for females aged 13 years or more, the threshold for surgical intervention should be lower.

A new surgical technique for congenital distichiasis

PURPOSE

To describe a new technique to treat congenital distichiasis.

METHODS

Case series of three distichiatic patients undergoing a novel surgical technique combining splitting of the lid margin with the distichiatic lashes, marginal tarsectomy in the affected area, and tarsoconjunctival graft obtained from the upper region of the tarsus. The graft was sutured at the exposed region of the marginal tarsectomy.

RESULTS

Good cosmesis was obtained in all cases and the lids margins healed completely with good surgical outcome and no lashes contacted the cornea postoperatively.

CONCLUSIONS

The split lamellae with a composite tarsoconjunctival graft results in satisfactory functional and cosmetic outcomes. The upper tarsal region represents an ideal donor site.

Relationship between lower eyelid epiblepharon and epicanthus in Korean children

PURPOSE

This study aimed to determine the relationship between lower eyelid epiblepharon and epicanthus in Korean children.

METHODS

We performed a retrospective review of the medical records and preoperative photographs of 119 patients. These patients were aged 18 years or younger who underwent lower lid epiblepharon repair from January 2010 to December 2012. We also included 119 age- and sex-matched controls.

RESULTS

The mean age of the patients was 5.7 years (range: 2-16 years) in both groups. The presence of an epicanthal fold was common in each group (98.3%). The inner intercanthal distance/interpupillary distance (IICD/IPD) ratio was significantly greater in the epiblepharon group than in the control group (mean: 0.70 vs 0.67, p<0.001), especially in those aged 5 years or older. The IICD/outer intercanthal distance ratio was also greater in the epiblepharon group than in the control group (mean: 0.48 vs 0.46, p<0.001). The IICD/IPD ratio decreased with growth in the control group, but it did not decrease with growth in the epiblepharon group. The configuration of the epicanthus, in which the upper skin fold formed a confluent fold with the lower eyelid, had a higher prevalence in the epiblepharon group than in the control group (p = 0.001), especially in those aged 5 years or older.

CONCLUSION

In early childhood (<5 years), the relationship between epicanthus and epiblepharon cannot be established because of the high prevalence of epicanthus in children with or without epiblepharon. In children aged ≥5 years, persistent epicanthus was related to severe epiblepharon formation requiring corrective surgery.

Conservative Management of Lower Eyelid Epiblepharon in Children

PURPOSE

Although much literature has focused on various techniques to repair epiblepharon, no study has addressed how frequently surgical intervention is required.

METHODS

The authors tabulated data from all patients with epiblepharon seen over the past 15 years.

RESULTS

Eighty-nine patients were included, 61 (69%) with tearing, discharge, conjunctival injection, or eye rubbing. Trichiasis was present in 15 cases (17%), 6 (7%) with corneal staining. In all cases, the initial treatment was conservative: antibiotic ointment or tear substitutes in 73 cases with trichiasis, symptoms of irritation, or corneal changes and observation in the remaining 16 cases. Three children (3%) were referred for eyelid surgery because of persistent symptoms. No patient had corneal scarring or long-term complications.

CONCLUSIONS

Although vision-threatening complications can result, a trial of topical antibiotic ointment and/or ocular lubricants was effective in nearly all patients. Most resolved with minimal symptoms. The few eventually requiring eyelid surgery suffered no long-term complications. The authors recommend a trial of conservative treatment before eyelid surgery is undertaken. [J Pediatr Ophthalmol Strabismus. 2017;54(1):15-16.].

Ectropion, entropion, trichiasis

Aim of this review was to describe ectropion, entropion and trichiasis and their therapy. These eyelid pathologies are characterised by common symptoms (redness, excessive tearing and irritation of the eye) and by altered balance of the anterior and posterior lamellae of the eyelids. They involve more frequently the inferior eyelid and the therapy is mainly surgical. Parasurgical therapy may play a role as a temporary measure.

Surgical correction of epiblepharon using an epicanthal weakening procedure with lash rotating sutures

BACKGROUND

To describe a new surgical technique in patients with lower eyelid epiblepharon using an epicanthal weakening procedure with lash rotating sutures.

METHODS

Charts of patients with epiblepharon who underwent surgical correction using an epicanthal weakening procedure with lash rotating sutures were reviewed retrospectively. The preoperative severity of corneal erosion was graded and compared with the postoperative keratopathy. Postoperative surgical outcomes, complications and subjective satisfaction were also evaluated.

RESULTS

202 eyes of 101 patients were evaluated in this study. The preoperative cilia-corneal touch was corrected and keratopathy was improved, especially towards the medial aspect of the lower lid. There were four eyes (2.0%) of recurrent cilia-corneal touch, but none required reoperation. Cosmetic outcomes were considered to be 'very satisfied' in 95 patients, 'satisfied' in 6 patients, and no patients indicated 'neutral' or 'dissatisfied' results.

CONCLUSIONS

In patients with epiblepharon with an epicanthal fold, surgical correction using an epicanthal weakening procedure with lash rotating sutures is a simple and effective method for correction, particularly when evaluating the medial portion of the lower eyelid. This method also produces a favourable cosmetic outcome with minimal scar formation.

Unilateral Congenital Eyelid Eversion Causing Marked Chemosis in a Newborn

A generally healthy male infant was born with unilateral congenital eversion of the upper eyelid causing considerable conjunctival injection and chemosis. Conservative medical management with topical lubrication and antibiotics resolved the condition within a few days.

Isolated accessory limb of lower eyelid with multiple dermal appendages

We report the first case in the English literature of an isolated occurrence of accessory limb with multiple dermal appendages in a ten-month-old boy. This condition presented at birth as a limb bud below the left eyelid, multiple dermal appendages in the adjacent part of the face below the left orbit and on the upper part of the face. No anomalies of the ocular structures or central nervous system were identified. Accessory limb with multiple dermal appendages, in the absence of a congenital cystic eye, is an extremely rare condition representing a benign aberration in the developing musculoskeletal system. We present the first of such a case and endeavour to explain the embryological basis behind it.

Osseous choristoma of the lateral canthus

Ocular osseous choristoma, a rare idiopathic benign deposit of bone, is typically a static epibulbar lesion that occurs sporadically in the supertemporal quadrant of an otherwise normal eye. The subject of this report is a unique U-shaped subcutaneous osseous choristoma that did not involve the eye itself but rather conformed to the right lateral canthus in an otherwise normal 2-year-old boy.

Blepharophimosis-ptosis-epicanthus inversus syndrome: objective analysis of surgical outcome in patients from a single unit

BACKGROUND

The aim was to objectively assess surgical outcome in blepharophimosis-ptosis-epicanthus inversus syndrome (BPES).

METHOD

Retrospective review of 14 consecutive patients with BPES. Mustardé double z plasty (at about age 4) and autogenous fascia lata Crawford brow suspension (9-12 months later) were used in all. One consultant performed all operations. Patient photographs were scanned and magnified for analysis. Preoperative and postoperative intercanthal distance, vertical palpebral aperture and cosmetic outcome were measured. Values were converted into ratios.

RESULTS

Bilateral (mildly asymmetrical) ptosis and symmetrical epicanthic folds were found in all preoperatively. Seventy-one per cent had severe folds. Preoperative intercanthal distance ratio range was 1.26-1.60 (non-BPES=1.0). Median reduction post surgery was 26% (P=0.001, Wilcoxon's signed ranks test). Patients with largest preoperative ratio displayed greatest correction (P=0.029). Mustardé technique completely abolished all epicanthic folds and unmasked prominent caruncles in all. Fifty per cent had mild scarring postoperatively in the medial canthal region. Median change in marginal reflex distance ratio (right)=22.2% (P=0.012), left=18.2% (P=0.008), Wilcoxon's signed ranks tests. Postoperatively all had formed eyelid creases with improved upper lid position symmetry.

CONCLUSIONS

This is the first known study objectively assessing surgical outcome in BPES. Mustardé double z plasty and Crawford autogenous fascia lata brow suspension are an effective surgical combination in the treatment of this syndrome, with overall cosmetic benefit.

Spinal extradural arachnoid cysts associated with distichiasis and lymphedema

Spinal extradural arachnoid cysts (SEDAC) are lesions communicating to the subarachnoid space of the spinal canal via a dural defect. SEDAC occupies intraspinal space and sometimes causes neurological disturbances. Although most reported cases are sporadic, several familial cases have been described, suggesting a genetic etiology. Here we report on a family with SEDAC inherited in an autosomal dominant mode. Detailed study showed that the family has the lymphedema-distichiasis syndrome. Among family members examined, a total of ten in two generations manifested all or some of the following features: SEDAC, distichiasis and lymphedema. Seven had spinal cysts, four had both SEDAC and distichiasis, and one had SEDAC distichiasis and lymphedema; three did not have SEDAC. These findings, together with rarity of both distichiasis and lymphedema in the general population, support that all of the ten members were affected with one clinical entity, the lymphedema-distichiasis syndrome. The distribution of features illustrates the variable expressivity of clinical manifestations. Although FOXC2 mutation analysis was not performed in our family, it is likely that SEDAC is a component manifestation of lymphedema-distichiasis syndrome and more consistent in our family than those reported.

Unilateral microblepharon

We report the clinical features and surgical treatment of a 15-year-old girl with unilateral microblepharon. The anomaly was characterized by a vertical shortage of upper and lower eyelid skin, causing nocturnal lagophthalmos, corneal exposure, and cosmetic deformity. Treatment consisted in hard-palate grafting and lateral tarsal strip suspension of the lower eyelid of the affected side. The outcome was considered satisfactory by the surgeon and by the patient. No further surgery was required.

Congenital eyelid imbrication syndrome

PURPOSE

To describe congenital eyelid imbrication syndrome and its possible pathophysiology.

DESIGN

Clinical observational case report.

METHODS

A full-term newborn was examined after a vaginal delivery and uneventful pregnancy.

RESULTS

The upper eyelids were overlapping the lower eyelids when the eyes were closed or when the newborn was asleep. The upper eyelids resumed normal position gradually over a week without causing any symptoms or residual sequelae.

CONCLUSIONS

Eyelid imbrication syndrome is a rare cause of congenital eyelid malposition. It may be caused by inborn laxity of the upper medial and lateral canthal tendons that are tightened during the postnatal period, causing resolution of this condition.

Congenital retraction of the lower eyelid: two case reports

PURPOSE

Idiopathic congenital retraction of the lower eyelid is rare. To further define the clinical features of this condition, we describe two new cases.

METHODS

Retrospective chart review.

RESULTS

In both cases, eye movements were restricted ipsilaterally and the condition was nonprogressive. CT scans showed mildly enlarged inferior and medial rectus muscles in one patient and normal muscles in the other. All other orbital structures were normal.

CONCLUSIONS

No definite cause for the lower eyelid retraction could be found, but it appeared to be related to a tight inferior rectus muscle. These patients may represent a variant of ocular fibrosis syndrome.

Supernumerary orbital muscle in congenital eyelid retraction

PURPOSE

Although several reports of supernumerary orbital muscles related to the levator palpebrae superioris have been published, no case has been associated with congenital eyelid retraction. This report describes an apparent causal relationship between an accessory levator muscle slip and congenital eyelid retraction.

METHODS

Case report and literature review.

RESULTS

Release of the anomalous muscle's attachment from the superior tarsal border alone resulted in resolution of the eyelid retraction.

CONCLUSIONS

Eyelid muscle anomalies may be a cause of congenital eyelid retraction. Ophthalmologists who treat eyelid disorders should be aware of this possibility when evaluating and operating on patients with congenital eyelid retraction.

A case of bilateral cryptophthalmia and euryblepharon with two-stage reconstruction

PURPOSE

A two-stage reconstruction of cryptophthalmia and euryblepharon occurring in the same patient is described.

METHODS

Case report.

RESULTS

The 7-month-old patient underwent forniceal reconstruction and upper eyelid reformation in a two-stage procedure that used the excess lower eyelid tissue present in euryblepharon to augment the cryptophthalmia-related upper eyelid deficiency.

CONCLUSIONS

To reconstruct the eyelids of this patient with both cryptophthalmia and euryblepharon, we were able to use the manifestations of one disorder to address the deficiencies of the other.

Microblepharon: a case report

Microblepharon is a rare congenital anomaly manifested by a vertical shortening of the eyelids. We describe the clinical presentation and surgical outcome of a patient with trisomy 21 and microblepharon. Microblepharon occurs in varying degrees and must be distinguished from ablepharon and cryptophthalmos. A variety of surgical options are available depending upon the degree of lid involvement.

Phakomatous choristoma: a case report and review of the literature

Phakomatous choristoma is a rare congenital lesion of the eyelid that can be clinically and/or histologically mistaken for a cyst, cutaneous adnexal neoplasm, or an ocular adnexal oncocytoma. Only 13 such cases have been previously described, mostly in the English language ophthalmic literature. Zimmerman reported the first case in 1971 and proposed the lesion to be of lenticular anlage origin, a theory that has been widely accepted. We report an additional case occurring in an 8-week-old male infant with a firm nodule of the right lower eyelid that was present since birth. A 15 x 12 x 2 mm circumscribed solid nodule with a homogenously white cut surface was surgically excised. Histologically, this lesion was comprised of cuboidal cells forming cystically dilated and irregularly branched ducts and cords within a densely fibrotic stroma. Also present were eosinophilic basement membranelike material, psammoma body-like calcifications and intraluminal degenerated ghost cells. The immunohistochemical profile of the epithelial cells included strong immunoreactivity for vimentin, focal weak staining for S-100, and negative staining for cytokeratin, epithelial membrane antigen, synaptophysin, and chromogranin. The irregularity of the ducts and cords of epithelial cells within the densely fibrotic stroma resembled an infiltrative neoplasm of cutaneous adnexal or lacrimal duct origin. However, the site of involvement, the peculiar basement membrane material, ghost cells, and immunohistochemical profile were features that helped to distinguish phakomatous choristoma from an infiltrative carcinoma. The correct identification of this lesion is essential to avoid an aggressive surgical excision, thus sparing the eyelid and lacrimal system. The purpose of this article is to bring attention to this rare entity, because it has not been described in either the dermatology or dermatopathology literature and furthermore, is not mentioned in any of the major dermatopathology texts.

Congenital cystic eye: report of two cases and review of the literature

A 13-month-old boy and a 2-week-old girl, who were considered to be anophthalmic and who later each developed a cystic lesion in the left orbit with protrusion of the lower eyelid, were studied. The fellow eye in case 1 was subsequently found to be microphthalmic with cyst and was normal in case 2. Histopathologic study of each case revealed a cyst lined externally by dense fibrous connective tissue to which skeletal muscle and adipose tissue were attached. The inner aspect of the cyst was lined by neuroglial tissue, possible immature retinal tissue, and cuboidal epithelium. No fully developed ocular structures or microphthalmos were identified. Fourteen cases of congenital cystic eye, including our cases, have been published in the English-language literature since 1964. We discuss and illustrate the findings in our cases and 10 others in which histopathologic findings were reported. Congenital cystic eye, microphthalmos with cyst, and microphthalmos with cystic teratoma should be suspected in patients with a small or unrecognizable eye and an orbital cystic mass that is detected by palpation or visualization.

The clinical spectrum of anti-Ro-positive cutaneous neonatal lupus erythematosus

BACKGROUND

Cutaneous neonatal lupus erythematosus (NLE) is an uncommon disease described mainly through isolated case reports.

OBJECTIVE

Our purpose was to examine the cutaneous spectrum, clinical associations, and course of disease in babies with anti-Ro-positive NLE.

METHODS

This is a retrospective case series evaluation of newborns with anti-Ro-positive NLE seen at a single ambulatory care university center over a 20-year period. Cases were drawn from a population of 3.2 million. Follow-up was at least 3 years.

RESULTS

Four boys and 14 girls were included in our evaluation. Distribution of skin lesions in 18 babies was as follows: face, 17; periorbital "owl-eye" or "eye mask" facial rash, 14; scalp, 15; arms and legs, 13; trunk and groin, 6. Crusted lesions were predominant in 3. Photosensitivity was seen in 12, and features of cutis marmorata telangiectasia congenita were observed in 4. In 17 neonatal lupus was not suspected until the dermatology consultation. Noncutaneous manifestations included thrombocytopenia in 4, cholestatic hepatitis in 3, and congenital heart block in 3. Four patients had residual telangiectasia that persisted for 3 or more years but eventually cleared in 2 patients. Three babies had dyspigmentation that spontaneously cleared within 22 months. None had atrophy or scarring.

CONCLUSION

Periorbital, scalp, and extremity lesions are common in cutaneous NLE. Crusted lesions predominated in male infants. In children selected by cutaneous involvement, thrombocytopenia and hepatic disease were present as frequently as cardiac disease and occurred more frequently in male babies with crusted skin lesions. Children with cutaneous NLE should be evaluated for hematologic and hepatic as well as cardiac involvement.

Bilateral abortive cryptophthalmos associated with oculocutaneous albinism

PURPOSE

To document a case of bilateral abortive cryptophthalmos associated with oculocutaneous albinism.

METHODS

We describe a 13-year-old female patient with blond skin and hair who had anomalous face and eyes first noted at birth.

RESULTS

The patient had fair hair and complexion, bilateral anomalous wedge of scalp hair, upper eyebrow and eyelid deformities, cup-shaped ears, broad based nose with depressed bridge and midline groove, iris transillumination and diffuse hypopigmentation and foveal hypoplasia in fundus examination.

CONCLUSION

Based on the clinical and laboratory findings, the reported case represents tyrosinase-positive oculocutaneous albinism together with bilateral abortive cryptophthalmos. The oculocutaneous albinism can either be an entirely new criterion to the whole syndrome of cryptophthalmos, or, more probably, the condition can be due to a double affliction which is primarily related with consanguinity of the parents. The importance of ante-natal diagnosis and genetic counseling are emphasized in such cases where the two recessive genes for two different conditions coexist.

Congenital, paradoxical lower eyelid retraction on upgaze

PURPOSE

Active lower eyelid retraction on upgaze is a rarely described finding. The purpose of this study is to describe the clinical and operative findings in two patients with this unique eyelid movement disorder.

METHODS

The authors identified active, unilateral lower eyelid retraction on upgaze in two patients who had no other ocular or systemic abnormalities.

RESULTS

Surgical extirpation of the lower eyelid retractor complex was carried out in both cases. During one of the procedures, performed under local anesthesia, the lower eyelid retractors were observed to retract actively on upgaze. Postoperatively, lower eyelid retraction on upgaze was not present in either case.

CONCLUSIONS

The authors are aware of only one other case report describing active, paradoxical lower eyelid retraction on upgaze. The mechanism of eyelid retraction in this previous report and in the two patients described herein is not known. The authors postulate that these unique cases may represent a previously unrecognized form of congenital, aberrant innervation of the oculomotor nerve.

Marcus Gunn Jaw-Winking Phenomenon: management and results of treatment in 19 patients

From 1980-1995, 19 patients displaying the Marcus Gunn Phenomenon (MGP) were treated in the Department of Maxillofacial Surgery of the Jagiellonian University in Kraków, Poland. Sixteen patients were operated on according to the Neuhaus method, in one case bilaterally. In three patients, the upper eyelid, after partial transsection of the levator muscle, was suspended from the frontal muscle on autogenous temporal fascia strips. At postoperative follow-up, the width and symmetry of the palpebral fissures were evaluated as well as persistent symptoms of synkinetic eyelid movement. In 13 (68.4%) patients, proper width and symmetry of the palpebral fissures were obtained, whereas in the remaining six (36.1%) marked improvement and decreased asymmetry of palpebral fissures were achieved. Pathological synkinesis disappeared totally in 16 (84.2%) of the patients on operated.

Congenital symblepharon (abortive cryptophthalmos) associated with meningoencephalocele

An 18-year-old male patient was first seen with right congenital symblepharon (abortive cryptophthalmos) and right frontal meningoencephalocele. There were no other affected members in the pedigree. Computed tomograms revealed that the right orbital roof was absent. Apart from a right harelip on the affected side, there were no other systemic abnormalities. The eye had light perception only. The upper eyelid connected with the globe and the cornea was totally opaque. Echographic studies showed that the eye was improperly developed. Electroencephalography detected slow-wave activity over the right frontoparietal region.

Moebius syndrome: report of case

This is a review of diagnosis, etiology and abnormalities of Moebius syndrome. The Moebius syndrome is rare and the cause is still unclear. It presents a case of a premature newborn baby with Moebius syndrome, showing unilateral facial nerve palsy, asymmetry of facial expression, inability to tightly close the right eyelids, asymmetry of the angles of the mouth with frequent drooling, poor sucking ability, dysphagia, extremity abnormalities and other cranial nerve involvement (VIII, IX, X, XI). He also had hypoplasia of the pons, a heart defect, and bilateral cryptorchism. The baby died of apnea on the 41st day after birth.

Correction of oriental epiblepharon by anterior lamellar reposition

Epiblepharon commonly occurs in Oriental infants and children, but usually corrects itself with age. Epiblepharon in adults is not uncommon and may be misdiagnosed or detected late. It causes symptoms of ocular irritation and inferior punctate corneal epithelial erosion. These can persist if surgical treatment is ineffective. A series of 15 lower lid epiblepharon in 10 adults is presented with the clinical features and surgical treatment by anterior lamellar reduction and repositioning. The surgical technique is discussed. All patients had significant symptomatic relief and correction of lash-corneal touch. Among 15 cases of epiblepharon, 3 with residual trichiasis post-operatively were further corrected by skin reduction and debulking of pretarsal orbicularis oculi to achieve total correction. Adequate skin reduction and debulking of orbicularis oculi, especially the pretarsal muscle, are essential in the anterior lamellar repositioning and effective correction of this condition.

Congenital shortening of the anterior lamella of all eyelids: the so-called ablepharon macrostomia syndrome

The so-called ablepharon macrostomia syndrome is an extremely rate congenital condition that includes abnormal ears, an enlarged, fishlike mouth, absence of lanugo, redundant skin, and vertical shortening of all eyelids. Only four cases have been described so far. In these cases the nature of the eyelid anomalies has not been clearly defined. We report one more case showing that the condition is better described as a severe microblepharon because only the anterior lamella of the eyelids is shortened. The literature about this condition is reviewed, and oculoplastic treatment is discussed.

Treatment of congenital forms of telecanthus with custom-designed titanium medial canthal tendon screws

A custom-designed, titanium medial canthal tendon screw (MCTS) was used successfully to correct telecanthus in three patients--two with blepharophimosis syndrome and one with congenital telecanthus. This device avoids the need for complicated transnasal wiring. Precise placement of the screw into the bone at the anterior lacrimal crest may be accomplished through a small skin incision. A through-and-through transverse hole in the screw just below its head allows passage of sutures and wires for internal fixation of the medial canthal tissues as well as for external fixation by a silicone stent. Correction of telecanthus with the MCTS is simpler and apparently a safer procedure than traditional transnasal wiring and, furthermore, may be easily combined with any soft tissue repair.

Lid crease and capsulopalpebral fascia repair in congenital entropion and epiblepharon

Forty-one eyelids of 21 patients with congenital entropion or epiblepharon underwent transcutaneous reconstruction of the eyelid crease and retractor (capsulopalpebral fascia). All of the patients demonstrated lack of cutaneous-capsulopalpebral fascia attachment. In contrast with the patients with epiblepharon, those with congenital entropion also had partial or complete absence of tarsal-capsulopalpebral fascia attachment. Surgical treatment included anastomosis of the capsulopalpebral fascia, tarsal border, and eyelid skin crease; no skin or muscle was removed. With a minimum follow up of 1 year, malposition recurred in 3 of the 33 (9%) eyelids with epiblepharon, and in none of the 8 eyelids with entropion.

Congenital ocular anomalies

This discussion provides an idea of the diversity and relative prevalence of certain congenital ocular conditions of horses. Many are not difficult to diagnose, yet curative treatment may be impossible. When dealing with owners of horses affected with unusual anomalies, responsible client service requires veterinarians to provide accurate information and to know where answers to unusual questions can be found. Again, most veterinarians never encounter all of the diverse congenital defects. As a result, the horse owner frequently receives misinformation. Hopefully, this brief coverage of congenital ocular anomalies will provide useful information and assist in appropriate communication to concerned parties.

Congenital macronodular juvenile xanthogranuloma of the eyelid

A large congenital eyelid mass prevented an infant from elevating his eyelid successfully. A small punch biopsy was initially interpreted as "consistent with a dermatofibrosarcoma protuberans." On the basis of this diagnosis, radical surgery was advised. Dermatofibrosarcoma protuberans, however, rarely affects children and seldom appears in the head and neck area. Because of the discrepancy between clinical and pathologic diagnoses, additional biopsies were performed, which disclosed the lesion to be a juvenile xanthogranuloma. The mass regressed after intralesional injections of corticosteroids. This is the first clinicopathologic description of congenital macronodular juvenile xanthogranuloma affecting the eyelids. The variability in the histologic composition of this large lesion may lead to a mistaken diagnosis of an aggressive condition that may provoke unnecessary radical surgery.

Congenital eyelid retraction

Twenty two patients with primary congenital lid retraction affecting either the upper or lower eyelids or both are presented. The clinical features and management are discussed in the hope that recognition of this clinical entity will prevent unnecessary investigation.

Surgical management of congenital upper-eyelid eversion

We describe a case of congenital eversion of the upper eyelids in which early surgery was performed to prevent occlusion amblyopia. The surgery, described here for the first time for this condition, consisted of using multiple suture placements to anatomically reposition the eyelids.