Congenital Anomolies - Lid Disorders
- A rare failure of lid differentiation
- Skin over eye (no lids or palpebral fissure) that often blends in with the cornea which is usually malformed.
- Congenital Coloboma
- Often well tolerated Involves primarily the upper lid
- no keratopathy
- Fusion of part or all lid margin: variant: Ankyloblepharon filiforme adnatum in which the lid margins are connected by fine strands.
- Usually involves the lower lid
- Distal part of tarsus rotated inward
- Lashes abrade the cornea causing keratopathy
- Permanent corneal damage is uncommon
- A horizontal fold of skin adjacent to either the upper or lower lid Tolerated well by the cornea
- More commonly the lower lid
- Often spontaneously resolves in the originally 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
- An accessory row of lashes growing from the meibomian orifices or posteriorly
- The lashes are thinner, shorter, less pigmented and often well tolerated
- Enlargement of the lateral part of the palpebral aperture with downward displacement of the temporal 1/2 of the lower lid.
- Crescentic fold of skin running vertically between the lids and overlying the inner canthus. There are three types:
- Inversus: If the fold is most prominent in the lower eyelid
- Tarsalis: (Most people) The fold is most prominent in the upper eyelid
- Palpebralis: If the fold is equally distributed in the upper and lower eyelids.
- Normal interpupillary distance but wide intercanthal distance
i.e. Waardenburg's syndrome
- not: Hypertelorism, which indicates increased distance between the
- Vertically and horizontally shortened Syndrome palpebral fissures
- Epicanthus inversus
- 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 might improve with age is delayed
- Lipodermoids are epibulbar, developmental growths of normal adipose in an abnormal site, ie. near the lacrimal gland and extending between the superior rectus and lateral rectus muscles posteriorly.
- Differentiation of benign lipodermoids from non-benign lesions is essential.
- When other ocular anomalies or systemic conditions are found in conjunction with lipodermoids then Goldenhar-Gorlin syndrome must be considered.
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