Lids and Lashes (pt 10)

Potential Dx for “why does my baby’s eyes look turned in?”

Epicanthal folds

Epicanthal folds

Normal variation in placement of orbicularis oculi fibers that causes tension of medial canthus skin

Seen in infants, up to 90% of asians, and 60% of Down syndrome

Epicanthal folds types

Epicanthus tarsalis (most common in asian), inversus, palpebralis, superciliaris (uncommon)

Epicanthus tarsalis

Fold is prominent along upper lid

Tx: Observation

Epicanthus inversus

Fold prominent along lower lid

Tx: Observation or surgery if amblyopia risk

Epicanthus palpebralis

Fold involves upper and lower lid

Tx: Observation

Epicanthus supraciliaris

Fold originates from brow and follows down to lacrimal sac

Tx: Observation

Epicanthal fold complications

Esotropia appearance from decrease in nasal sclera showing

Check Purkinje images

Potential Dx for “my child’s eyelids look different”

Congenital coloboma

Congenital coloboma

Full thickness notch or gap in lid margin from failure of lid ectoderm fusion

Systemic associations: Goldenhar syndrome, Treacher Collins Syndrome

Congenital coloboma clinical findings

• Unilateral/bilateral notch in lid margin

• Upper lid → Affects medial (Goldenhar)

• Lower lid → Affects lateral (Treacher Collins)

Congenital coloboma complications

PEE (dryness)

Congenital coloboma Tx

• Lubrication

• Surgical repair