J Korean Ophthalmol Soc.  2010 Nov;51(11):1520-1524. 10.3341/jkos.2010.51.11.1520.

Surgical Repair of Canalicular Defects and Congenital Eyelid Colobomas Associated with Tessier No. 3 Cleft

• Park SW
• Kim NJ
• Choung HK
• Khwarg SI

• KMID: 2213989
• DOI: http://doi.org/10.3341/jkos.2010.51.11.1520

Abstract

PURPOSE
To report a single case of surgical repair of the canalicular defects and congenital eyelid colobomas associated with Tessier No. 3 craniofacial cleft.
CASE SUMMARY
A one-month-old girl presented with eyelid colobomas and discharges from the eyes. The patient was diagnosed with a Tessier No. 3 craniofacial cleft with bilateral lower eyelid colobomas medial to the puncta. At the age of 55 months, examination under general anesthesia revealed mid-canalicular obstructions in both lower canaliculi. After pentagonal excision of eyelid colobomas in the left upper and both lower eyelids, both ends of the canaliculi were found at the cut edge of the lower eyelids. After the repair of canalicular defects and bilateral nasolacrimal duct silicone tube intubation, the primary closure of the eyelid defect was performed layer by layer. Although there was no subjective improvement of epiphora in the left eye, a subjective improvement of epiphora in the right eye was achieved, and tear meniscus height in the right eye was halved. Additionally, the eyelid colobomas were cosmetically well repaired at postoperative 6 weeks. The patient still had mild tearing symptoms, but did not complain any longer of discharge at postoperative 4 months.
CONCLUSIONS
Tessier No. 3 craniofacial cleft with eyelid colobomas can be associated with canalicular defects and nasolacrimal duct obstructions. Surgical repair of the canalicular defects associated with eyelid colobomas should be considered to achieve a functional recovery of the lacrimal drainage system.

Keyword

Canalicular defect; Craniofacial cleft; Eyelid coloboma; Symblepharon; Tessier No. 3

MeSH Terms

Anesthesia, General
Coloboma
Drainage
Eye
Eyelids
Humans
Intubation
Lacrimal Apparatus Diseases
Nasolacrimal Duct
Silicones
Silicones

Figure

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  Figure 1. Photographs of the patient before surgery. (A) Intact right upper eyelid. (B) Right lower eyelid coloboma medial to the punctum (C) Preoperative eyelid photograph. Left eyebrow defect. (D) Left upper eyelid coloboma lateral to the punctum, and symblepharon between the left medial canthus and medial conjunctiva adjacent to the limbus. (E) Left lower eyelid coloboma medial to the punctum.

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  Figure 2. Photographs of the patient after surgery. (A) Two weeks after surgery. Eyelid colobomas were well reconstructed. The silicone tubes were well positioned and tear meniscus heights were high in both eyes. (B) Six weeks after surgery. Right tear meniscus height was decreased. (C) Four months after surgery. Tear meniscus heights were decreased and eye discharge completely resolved.

Reference

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