Eyelid Coloboma Treatment & Management

Updated: Jul 30, 2018
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

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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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.

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Long-Term Monitoring

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.

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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.

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