Congenital Anomolies - Lid Disorders

  • Cryptophthalmos
    • A rare failure of lid differentiation
    • Skin over eye (no lids or palpebral fissure) that may be 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.


Congenital Entropion

  • Usually involves the lower lid
  • Distal part of tarsus rotated inward
  • Lashes abrade the cornea causing keratopathy
  • Permanent corneal damage is uncommon

Image showing a case of Entropion, where the eyelid is inverted, causing irritation and discomfort. The image depicts the condition clearly, highlighting the affected area of the eye.


  • 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 initially 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:
    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.



  • 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 possibly 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. 

Image depicting eyelid disorders