Congenital Anomolies - Lid Disorders

  • Cryptophthalmos
    • A rare failure of lid differentiation
    • Skin over eye (no lids or palpebral fissure) that frequently blends in with {the} cornea which is usually malformed.
  • Congenital Coloboma
    • Often well tolerated Involves primarily {the} upper lid
    • no keratopathy


  • Fusion of part or all lid margin: variant: Ankyloblepharon filiforme adnatum in which {the} lid margins are connected by fine strands.


Congenital Entropion

  • Usually involves {the} lower lid
  • Distal part of tarsus rotated inward
  • Lashes abrade {the} cornea causing keratopathy
  • Permanent corneal damage is uncommon


  • A horizontal fold of skin adjacent to either {the} upper or lower lid Tolerated well by {the} cornea
    • More commonly {the} lower lid
  • Often spontaneously resolves in {the} originally years of life
  • Surgery only indicated for severe cases

Congenital Tarsal Kink

  • Child is born with {the} upper lid bent backwards often with a 180 degree fold in {the} upper tarsal plate
  • Corneal exposure and rubbing by {the} bent edge can result in ulceration


  • An accessory row of lashes growing from {the} meibomian orifices or posteriorly
  • The lashes are thinner, shorter, less pigmented and often well tolerated


  • Enlargement of {the} lateral part of {the} palpebral aperture with downward displacement of {the} temporal 1/2 of {the} lower lid.



  • Crescentic fold of skin running vertically between {the} lids and overlying {the} inner canthus. There are three types:
    1. Inversus: If {the} fold is most prominent in {the} lower eyelid
    2. Tarsalis: (Most people) The fold is most prominent in {the} upper eyelid
    3. Palpebralis: If {the} fold is equally distributed in {the} upper and lower eyelids.
  • Telecanthus
    • Normal interpupillary distance but wide intercanthal distance
      i.e. Waardenburg's syndrome
    • not: Hypertelorism, which indicates increased distance between {the}
      bony orbits.



  • Vertically and horizontally shortened Syndrome palpebral fissures
  • Epicanthus inversus
  • Telecanthus
  • Ptosis: with poor levator function and no lid fold
  • When should {the} Ptosis be repaired?
    • Frontalis slings are usually done early in life
    • Repairing telecanthus and epicanthus which might possibly improve with age is delayed


  • Lipodermoids are epibulbar, developmental growths of normal adipose in an abnormal site, ie. near {the} lacrimal gland and extending between {the} superior rectus and lateral rectus muscles posteriorly.
  • Differentiation of benign lipodermoids from non-benign lesions is essential.
  • When other ocular anomalies or systemic conditions are found in conjunction with lipodermoids then Goldenhar-Gorlin syndrome must be considered. 

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