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A 5-day-old-newborn with a large right upper eyelid coloboma
Digital Journal of Ophthalmology 2017
Volume 23, Number 3
September 28, 2017
DOI: 10.5693/djo.03.2017.08.001
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Dalia V. Zhang, BS | Cleveland Clinic Cole Eye Institute, Cleveland, Ohio
Rao V. Chundury, MD, MBA | Glick Eye Institute, Indiana University, Indianapolis, Ohio
Alexander D. Blandford, MD | Cleveland Clinic Cole Eye Institute, Cleveland, Ohio
Julian D. Perry, MD | Cleveland Clinic Cole Eye Institute, Cleveland, Ohio
Differential Diagnosis
In this patient the differential diagnosis included Goldenhar syndrome, CHARGE syndrome, and isolated eyelid coloboma. There were several options for how to repair upper eyelid colobomas. Direct closure, which generally yields excellent functional and cosmetic outcomes, was the most simple and straightforward surgical option.(1) However, application of this technique is greatly limited by defect size and lid laxity, because undue tension could easily result in notch formation and trichiasis.(2) For colobomas larger than 1/3 of the horizontal lid margin, additional tissue must be mobilized in order to avoid these complications. External canthotomy and cantholysis and semicircular or rotational flaps are often used for defects involving up to 50% of the lid margin, whereas the Cutler-Beard technique is generally reserved for defects of larger size.(3) Because two-stage techniques and prolonged occlusion of the pupil at this age can cause significant amblyopia, one-stage techniques, such as sliding tarsoconjunctival/myocutaneous flaps,(4) skin grafts,(5) or large lateral myocutaneous flaps have been employed for large defects.(3) However, these procedures carry significant risks for wound morbidity, prolonged healing time, and visible scarring. Often, the recruited or grafted tissue is not lash bearing. This compromises both the cosmetic and functional result, because granulation can result in a keratinized lid margin, with subsequent mechanical keratopathy.(2) Although not specifically reported before to repair upper eyelid colobomas, internal cantholysis with subsequent direct closure is a one-step procedure that has been employed successfully for closure of full-thickness defects of up to 25 mm in adults following excision of cutaneous lid malignancies.(6)
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