eMedicine Specialties > Ophthalmology > Lid

Eyelid Coloboma: Follow-up

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Contributor Information and Disclosures

Updated: Nov 2, 2007

Follow-up

Further Outpatient Care

  • Perform corneal examination with staining to ensure that corneal abrasion from sutures is not present and to monitor corneal health or recovery from previous compromise.
  • Ensure that other coexisting anomalies have been ruled out and that all consultations have been performed.
  • Monitor patients closely for amblyopia, and treat this condition if necessary.

Inpatient & Outpatient Medications

  • Topical antibiotic or combination ointment, such as TobraDex, should be administered to the operated eye(s) 4 times a day for 1-2 weeks following surgery.

Complications

  • Amblyopia is the most common complication of any pediatric ocular problem. It must be ruled out and, if present, treated.
  • Eyelid-sharing procedures, such as the Hughes procedure and the Cutler-Beard (unmodified) procedure, should be used with caution (or not at all) in the pediatric population.
  • Planned excision of associated limbal dermoids should be cautiously undertaken. Pseudopterygium and symblepharon, as well as perforation, are common complications. Lamellar grafts have been advocated.
  • For lower lid colobomas, consider the mandibulofacial dysostosis syndromes, especially Treacher Collins syndrome or Franceschetti syndrome. Treacher Collins syndrome is associated with mandibular hypoplasia, which is a consistent feature of mandibulofacial dysostosis.
  • For upper lid colobomas, consider oculoauricular dysplasia (Goldenhar syndrome).
  • Amniotic band syndrome often presents with corneal opacities and facial clefts, in addition to eyelid colobomas.

Prognosis

  • Prognosis is excellent to good depending on the size of the lesion and the speed of therapy.

Patient Education

  • Genetic consultation is highly recommended, especially for patients with associated syndromes, such as Treacher Collins syndrome, which is autosomal dominant with variable penetrance and expressivity.

Miscellaneous

Medicolegal Pitfalls

  • Amblyopia as a result of using a lid-sharing procedure is a medicolegal pitfall.
 


More on Eyelid Coloboma

Overview: Eyelid Coloboma
Differential Diagnoses & Workup: Eyelid Coloboma
Treatment & Medication: Eyelid Coloboma
Follow-up: Eyelid Coloboma
References
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References

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  2. Dibben K, Rabinowitz YS, Shorr N, Graham JM Jr. Surgical correction of incomplete cryptophthalmos in Fraser syndrome. Am J Ophthalmol. Jul 1997;124(1):107-9. [Medline].

  3. Nouby G. Congenital upper eyelid coloboma and cryptophthalmos. Ophthal Plast Reconstr Surg. Sep 2002;18(5):373-7. [Medline].

  4. Marles SL, Greenberg CR, Persaud TV, Shuckett EP, Chudley AE. New familial syndrome of unilateral upper eyelid coloboma, aberrant anterior hairline pattern, and anal anomalies in Manitoba Indians. Am J Med Genet. Apr 1 1992;42(6):793-9. [Medline].

  5. Agashe AP, Adrianwala SD, Bhatti SS, Contractor CP. Fraser's syndrome. J Postgrad Med. Oct-Dec 1992;38(4):209-10, 208. [Medline].

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Further Reading

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Keywords

eyelid defects, congenital eyelid defects, Treacher Collins syndrome, mandibulofacial dysostosis, cryptophthalmos, facial deformity

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Chairman, Department of Ophthalmology and Otorhinolaryngology, Director of Fellowship Training Program, St Francis Medical Center; Associate Professor, Department of Surgery, University of Hawaii School of Medicine
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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