Eyelid Disorders

Cryptophthalmos

Cryptophthalmos is a congenital eyelid malformation. It is evident when the eyelids fail to separate thereby creating an inability to see. No eyelids or palpebral fissure are apparent. This is a rare condition and may coincide with Fraser syndrome. The intent of surgery is to create functional eyelids and separate fused skin to improve eye development and function. Orbital development is important in determining a surgical path.

Congenital Coloboma

Congenital coloboma occurs during embryonic development and results when there is a gap in the iris of the eye. Any defect in the iris that allows light to enter the eye, other than through the pupil, is called a coloboma. There are treatments that can help patients make the most of their vision.

Ankyloblepharon

Ankyloblepharon is another rare congenital condition defined by the fusion of the upper and lower eyelids by webs of skin. It occurs when there is partial or complete adhesion between the margins of the eyelids. Treatment involves surgical separation of the eyelids, and is performed in early childhood to prevent complications such as vision loss or eye infections.

Congenital Entropion

Congenital entropion is a condition present at birth and involves the lower lid margin rotating inward. Malformed lower lid retractors, posterior lamella vertical insufficiency, or kinking of the tarsal plate can all play a part in this abnormality. When the tarsus rotates inward, a patient’s lashes scrape the cornea causing keratopathy. Permanent corneal damage is uncommon in this rare condition but surgical correction is often necessary.

Epiblepharon

Epiblepharon is a congenital condition involving a fold of eyelid skin that forces lashes against the eye. This condition is most common in the lower lids and often resolves itself in the first few years of life. Surgery becomes necessary with more severe cases.

Congenital Tarsal Kink

Tarsal kink syndrome is characterized by horizontal kink within the upper tarsal plate. This is a rare congenital condition and involves upper lid bending backwards, sometimes with a 180-degree fold in the upper tarsal plate. Corneal exposure and rubbing are uncomfortable and can lead to ulceration. Tarsal kinks often require surgical correction.

Distichiasis

Distichiasis involves abnormal lash growth from the meibomian glands on the posterior lamella of the tarsal plate. It can result in an accessory row of lashes which are sometimes tolerated and other times cause irritation, discomfort, and vision problems. Surgical removal is mostly avoided as there are other methods to remove the undesirable or irritating accessory lashes.

Euryblepharon

Euryblepharon is a congenital eyelid anomaly involving eyelids being horizontally enlarged and vertically shortened. It is a rare condition characterized by enlargement of the lateral part of the palpebral aperture along with displacement of the temporal half of the lower lid. Surgical options include eyelid reconstruction, canthoplasty, and eyelid tightening.

Epicanthus

Epicanthus occurs when a fold of skin stretches from the upper to the lower eyelid, partially covering the inner canthus. It is common in young children and people of East Asian descent. There are three types of epicanthus, each defined by where the fold is most prominent. Surgery is an option to correct this anomaly.

Telecanthus

When there is an abnormally increased distance between the medial canthi, telecanthus is present. It is defined by wide spacing between the inner corners of the eye. Surgical intervention may be necessary to correct telecanthus and involves a procedure to shorten the medial canthal tendons or repositioning the bony structures that support the eyelids.

Blepharophimosis

Blepharophimosis is a congenital anomaly defined by shortened palpebral fissures and poor levator function. In these cases, the eyelids are not fully developed. This results in patients being unable to open their eyes as far as usual. Parts of the eye may be permanently covered. Surgical procedures can correct the eyelid malformations in patients with this malfunction.

Lipodermoids

Lipodermoids are epibulbar growths of the adipose tissue. A conjunctival lesion, the lipodermoid is located near the temporal fornix and is composed of adipose tissue and dense connective tissue. Distinguishing the difference between benign and malignant lipodermoids is important. Most small lipodermoids do not require treatment but more severe cases may require debulking or at least partial excision.