1. Signs + An extra horizontal fold of skin steetches across the anterior lid margin and the lashes are directed vertically, especially in the medial part of the tid (Fig. 3.daand b). * When the fold of skin is pulled down the lashes turn out and the normal location of the lid becomes apparent (Fig. 3.4c), 2, Treatment is not required in the majority of cases because spontaneous: resolution with age is the rule. Persistent cases are treated by excising a strip of skin and muscle, and fixation of the skin crease to the tarsal plate (Hotz procedure — Fig. 3.4d, e and f) Congenital entropion Upper lid entropion Upper lid entropion is usually secondary 10 mechanical effects of microphthalmos which cause variable degrees of ‘upper lid inversion, Lower lid entropion Lower lid entropion is caused by improper development of the inferior retractor aponeurosis. I. Signs © In-turning of the entire lower eyelid and lashes with absence of the lower lid crease (Fig, 3.5). © When downward pressure is applied to the lid, the entire id becomes pulled away from the globe. 2. Treatment involves the Hoty procedure. Fig. 3.3 Blepharophimosis syndrome Coloboma A coloboma is an uncommon, unilateral or bifateral, partial or full-thickness eyelid delet. It occurs when eyelid development is incomplete, due to either failure of migration of lid ectoderm to fuse the lid folds or to mechanical forces such as amniotic bands, 1. Upper lid _colobomas occur at the junction of the middle and inner thirds and may occasionally be associated with Goldenhar syndrome (Fig. 3.64), 2. Lower tid colobomas occur at the junction of the middle and outer thirds and are frequently associated with systemic conditions, most notably Treacher Collins syndrome (Fig. 3.6b) and amniotic band syndrome, 3. Treatment of small defects involves primary closure, while large defects require skin grafts and rotation flaps. Euryblepharon 1. Signs © Horizontal enlargement of the palpebral fissure with associated lateral canthal malposition and lateral ectropion (Fig. 3.7) # In severe cases it may result in lagophthalmos and ‘exposure keratopathy: 2. Associations include lateral displacement of the proxi- mal lactimal drainage system, a double row of meibomian sland orifices. telecanthus and strabismus. 3. Treatment involves: lateral canthal tightening or tarsorchaphy:, Microblepharon Microblepharon is characterized by small eyelids, often associated with anophthalmos (see Fig. 3.30a). Ablepharon 1. Signs. Deficiency of the anterior lamellae of the eyelids 2. Treatment involves reconstructive skin geal 3. Systemic anomalies. \blepharon-macrostomia syndrome characterized by an enlarged fish-like mouth due to fasion detects, ear and genital anomalies. and redundant skin (Fig. 3.8) Cryptophthalmos 1. Signs. In complete eryptophthaimos the lds are replaced by a layer of skin which is fused with & microphthalios (Fig. 3.9a), Incomplete eryptophthalmos is characterized