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   Table of Contents      
ARTICLES
Year : 1981  |  Volume : 29  |  Issue : 1  |  Page : 41-42

Unilateral cryptophthalmos


1 Department of Ophthalmology, G.R. Medical College & J.A. Group of Hospitals, Gwalior, India
2 Department of Anatomy, G.R. Medical College & J.A. Group of Hospitals, Gwalior, India

Correspondence Address:
G C Baijal
14-C, J-A. Hospital Campus, Gwalior-474009
India
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Source of Support: None, Conflict of Interest: None


PMID: 7287125

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How to cite this article:
Baijal G C, Agarwal M L, Chaurasia B D. Unilateral cryptophthalmos. Indian J Ophthalmol 1981;29:41-2

How to cite this URL:
Baijal G C, Agarwal M L, Chaurasia B D. Unilateral cryptophthalmos. Indian J Ophthalmol [serial online] 1981 [cited 2020 May 27];29:41-2. Available from: http://www.ijo.in/text.asp?1981/29/1/41/30991

Cryptophthalmos is a rare malformation characterized by a complete failure of the eye lids to develop so that the eye remains hidden beneath the uninterrupted skin extending from the forehead to the cheek. The last comprehen­sive review was that of Francois[1] who descri­bed the details of 41 cases and added five cases of his own. Since then, reports on cryptoph­thalmos have been published occasionally even from India.[2],[3],[4],[5],[6],[7], [8,[9] Cryptophthalmos is usually bilateral. In Francois[[1] review, there were only five reported cases of the unilateral cryptophthalmos. The present case in this regard is interesting being unilateral.


  Case report Top


A male child, 8 days old, presented with a complete developmental fusion of the right eyelids, concealing the eyeball beneath the con­tinuous skin [Figure - 1]. The child was a full term normal delivery from the non­consanguineous Hindu parents. The history of any ailment or medication during the first trimester of pregnancy was negative. The perso­nal and family histories were noncontributory.

Upon examination, the movements of the concealed eyeball could be well perceived on the surface of the skin. The eyebrow, lids, cilia and palpebral fissure on that side were absent, although a linear horizontal groove measuring 5 mm. in length was present toward the lateral side along a line of the expected palpebral fissure. Palpation revealed the compressible eyeball beneath the skin. The intraocular ten­sion was normal digitally. Apart from the developmental abnormality of the right eye, the child was normal and healthy.

Surgically, the eyeball was exposed after incising along the fused eyelids. The overlying skin was adherent to the eyeball, but its separa­tion and retraction was comparatively easier. The procedure was attended by the usual bleeding. A translucent and thin cornea was seen. The vascularized tissue covering the cornea, limbus and sclera was carefully cleaned as far as possible. The anterior chamber appear­ed deep, but details about the other deeper structures could not be made out. The lid margins were made by the interrupted sutures including the skin and subcutaneous tissue.

The postoperative period, with repeated attempts to break the new adhesions between the lids and eyeball, was otherwise uneventful, and the child was discharged from the hospital on the eighth postoperative day. The parents were instructed to bring the child to the hospi­tal twice a week for ascertaining the patency of the artificial conjunctival sac. On every occa­sion difficulty was experienced in separating the lids from the eyeball. Each time new adhe­sions were found, the breakage of which caused considerable bleeding. Ultimately, within a period of four weeks the lids became completely adherent to the eyeball, leaving a narrow palpe­bral fissure through which the opaque and dry cornea could be seen.


  Discussion Top


The anomaly is often associated with diverse developmental abnormalities of the body, namely syndactyly (about 33% of cases), genital anomalies (about 25% of cases) ocular anomalies involving the fellow eye in unilateral cases of cryptophthalmos, mental retardation, mening­oencephalocele, laryngeal atresia, cleft palate, harelip, umbilical hernia, renal aplasia, and vesical and anal atresia. The present case is significant in that the anomaly of the eye was isolated and was not associated with any other anomaly of the body.

Waring and Shields[7] reviewed the possible pathogenetic mechanisms resulting in crypto­phthalmos, although none of them is entirely satisfactory. The proposed theories (Duke­Elder[9]. Francois[1]) include (1) primary failure of the ectodermal and mesodermal differentiation, (2) intrauterine inflammation producing fusion of the eyelids to the globe, (3) amnio­chorionic bands with pressure on the eyelids, (4) defective differentiation of the conjunctiva resulting in symblepharon.


  Summary Top


A sporadic cases of an isolated, unilateral complete cryptophthalmos in a male child born to a nonconsanguineous Hindu couple is repo­rted. The surgical attempt to separate the eyelids with a hope to achieve at least a partially functioning eye was a failure.[10]

 
  References Top

1.
Francois, J., 1965, Ophthalmologica. 150: 215.   Back to cited text no. 1
    
2.
Sugar, H.S., 1968, Amer. J. Ophthalmol. 66: 897.  Back to cited text no. 2
    
3.
Dada, V K. and Agarwal, L.P., 1969, Orient. Arch. Ophthalmal. 7 : 126.  Back to cited text no. 3
    
4.
Parmar, I.P.S., Chandra, P. and Singh, I., 1972, Orient. Arch. Ophthalmol. 10 : 273.  Back to cited text no. 4
    
5.
Singh, N., 1973, Antiseptic. 70: 125.  Back to cited text no. 5
    
6.
Das, B. 1974, Ind. J. Ophthalmol. 22 : 24  Back to cited text no. 6
    
7.
Waring, G.O. and Shields, J.A., 1975, Amer J. Ophthalmol. 79 : 437.  Back to cited text no. 7
    
8.
Sen, S.C., 1977, Ind. J. Ophthalmol. 24 : 29  Back to cited text no. 8
    
9.
Duke-Elder's, 1963, System of Ophthalmology.Vol. 3, Part 2, p. 832, Henry Kimpton, London.  Back to cited text no. 9
    
10.
Gupta, G.P. and Gogi, R., 1981, Ind. J.Ophthalmal. 28 :231.  Back to cited text no. 10
    


    Figures

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