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Eyelid Coloboma Treatment & Management

  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 21, 2016
 

Medical Care

Corneal protection is the primary goal in the medical treatment of eyelid colobomas. Modalities that can be used either for small defects or for large defects awaiting definitive surgical therapy include the following:

  • Artificial tears and ointment
  • Moist chamber optical bandages
  • Bedtime patching
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Surgical Care

Corneal protection and cosmesis are indications for surgical therapy. The surgical procedure used depends on the size and the location of the defect.

If the eyelid coloboma is small and well managed with topical lubrication, then surgery may be delayed until later in childhood. Usually, it is corrected by direct closure. The edges of the defect are freshened with sharp incisions, and precise anastomosis is preformed. The lid margin is brought together using a 2-layer approximation of the tarsus and the skin. Lateral cantholysis and placement of near-far, far-near sutures may be necessary to minimize horizontal tension.

A recent paper describing late repair (age 17 y) of a 10-mm upper eyelid coloboma has been described by Lee et al.[6]

If the eyelid coloboma is large, immediate surgical closure is usually needed to prevent corneal compromise. A 2-stage reconstruction may be required for those defects that occupy greater than 40-50% of the lid. The surgical procedure used depends on the involved lid, as follows:

  • Lower lid: The modified Hughes procedure is as follows: upper lid tarso-conjunctival flap (for tarsus layer) with retroauricular skin flap (for skin layer).
  • Upper lid: The modified Cutler-Beard procedure is as follows: lower lid tarso-conjunctival flap (for tarsus layer) with retroauricular skin flap (for skin layer).
  • Alternate techniques for either the upper lid or the lower lid include the following: a semicircular flap from the lateral canthal area (Tenzel or modified Tenzel flap) and a full-thickness lid rotational flap.
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Consultations

See the list below:

  • Pediatrician and/or neonatologist
  • Geneticist
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Contributor Information and Disclosures
Author

Mounir Bashour, MD, PhD, CM, FRCSC, FACS Assistant Professor of Ophthalmology, McGill University Faculty of Medicine; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, PhD, CM, FRCSC, 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, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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. 1997 Jul. 124(1):107-9. [Medline].

  3. Nouby G. Congenital upper eyelid coloboma and cryptophthalmos. Ophthal Plast Reconstr Surg. 2002 Sep. 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. 1992 Apr 1. 42(6):793-9. [Medline].

  5. Yeung A, Amor D, Savarirayan R. Familial upper eyelid coloboma with ipsilateral anterior hairline abnormality: two new reports of MOTA syndrome. Am J Med Genet A. 2009 Feb 15. 149A(4):767-9. [Medline].

  6. Lee H, Takahashi Y, Ichinose A, Kakizaki H. Reconstruction of a Congenital Upper Eyelid Coloboma Using a Lamellar-Based Technique. Ophthal Plast Reconstr Surg. 2013 Oct 18. [Medline].

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