Кански Клиническая офтальмология

Cryptophthalmos

Cryptophthalmos is a rare congenital anomaly in which the eyelids are absent, replaced by a continuous layer of skin.

  • Complete cryptophthalmos. A microphthalmic eye (Fig. 1.85A) is covered by a fused layer of skin with no separation between the lids.

  • Incomplete cryptophthalmos is characterized by rudimentary lids and microphthalmos (Fig. 1.85B).

  • Fraser syndrome is a dominantly inherited condition in which cryptophthalmos is a common finding; other features can include syndactyly, urogenital and craniofacial anomalies.

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Fig. 1.84 (A) Upper lid colobomas; (B) lower lid colobomas in Treacher Collins syndrome

(Courtesy of U Raina – fig. A)

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Fig. 1.85  Cryptophthalmos. (A) Complete; (B) incomplete (Courtesy of D Meyer – fig. A)

Euryblepharon

Euryblepharon refers to horizontal enlargement of the palpebral fissure with associated lateral canthal malposition and lateral ectropion (Fig. 1.86); lagophthalmos and exposure keratopathy may result.

Microblepharon

Microblepharon is characterized by small eyelids, often associated with anophthalmos (Fig. 1.87).

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Fig. 1.86  Euryblepharon

(Courtesy of D Taylor and C Hoyt, from Pediatric Ophthalmology and Strabismus, Elsevier 2005)

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Fig. 1.87  Microblepharon associated with anophthalmos

Ablepharon

Ablepharon consists of deficiency of the anterior lamellae of the eyelids (Fig. 1.88A); treatment involves reconstructive skin grafting. Ablepharon-macrostomia syndrome is characterized by an enlarged fish-like mouth (Fig. 1.88B), ear, skin and genital anomalies.

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Fig. 1.88 (A) Ablepharon; (B) following reconstruction – note enlarged fish-like mouth

(Courtesy of D Taylor and C Hoyt, from Pediatric Ophthalmology and Strabismus, Elsevier 2005 – fig. A; H Mroczkowska – fig. B)

Congenital upper lid eversion

Congenital upper lid eversion is a rare condition more frequently seen in infants of Afro-Caribbean origin, in Down syndrome and in congenital ichthyosis (collodion skin disease – Fig. 1.89). It is typically bilateral and symmetrical. It may resolve spontaneously with conservative treatment or require surgery.

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Fig. 1.89  Congenital upper lid eversion in a patient with ichthyosis

(Courtesy of D Meyer)

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Fig. 1.90  Ankyloblepharon filiforme adnatum

(Courtesy of D Taylor and C Hoyt, from Pediatric Ophthalmology and Strabismus, Elsevier 2005)

Ankyloblepharon filiforme adnatum

In ankyloblepharon filiforme adnatum the upper and lower eyelids are joined by thin tags (Fig. 1.90); most cases are sporadic. Treatment involves transection with scissors; anaesthesia is not required.

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