|Year : 1966 | Volume
| Issue : 5 | Page : 225-226
Bilateral cryptophthalmos (ablepharon)
Ishwarchandra, JS Mulak
Department of Ophthalmology, Medical College, Nagpur, India
|Date of Web Publication||17-Jan-2008|
Department of Ophthalmology, Medical College, Nagpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ishwarchandra, Mulak J S. Bilateral cryptophthalmos (ablepharon). Indian J Ophthalmol 1966;14:225-6
Cryptophthalmos is a condition of complete absence of lid folds. The ectoderm which should normally form conjunctiva and corneal epithelium is differentiated into skin to protect the eye ball. Two types of cryptophthalmos may exist, one due to initial failure of lid folds (ablepharon by agenesis), the other due to subsequent destruction or absorption of conjunctival sac (ankyloblepharon by ankylosis).
The condition is rare, some 50 cases have been recorded since Zehender and Manz's original observation (1872). Avizonis (1928) collected 37 cases from 27 authors of which 29 were typical and only 20 bilateral. In India Pahwa (1960) has reported 2 cases and Gupta and Saxena (1962) one case of bilateral cryptophthalmos.
This is usually associated with other anomalies, frequently deformities connected with the "fissures of face" e.g. cleft palate. hare lip, facial cleft. Other anomalies met with are dermoids, syndactly of hands and feet, genital and deep seated anomalies such as aplasia of kidney and atrasia of larynx.
| Case Report|| |
A male child, 3 days old was admitted on 21st December, 1965, as the parents observed that both the eye balls were completely covered by skin.
| Obstetrical and Family History|| |
The pregnancy was uneventful and the birth of the child was normal. The present case is the second child. The first female child died after 9 days.
There is no history of such deformity in the family.
On examination the growth of the child was found normal. There were no other developmental anomalies except cleft palate of group II (Davis and Ritchie). The nose was flat and broad.
The eyebrows were partly developed, especially on the lateral side [Figure - 1], lashes were absent.
Both the eyes were completely covered by skin, which was continuous with the skin of the forehead and cheeks. There was no linear scar in the region of the palpebral aperture. The rounded prominence of the eye ball could be seen and felt under the skin, which sometimes showed spontaneous movements. There was no wrinkling of the skin or any movement of the eye ball when exposed to light.
X-ray of skull and orbit was normal.
The rounded prominence on the right side was explored on 6-1-1966, by a horizontal incision about I cm. long in the region of the palpebral fissure and deepened to an extent of 4-5 mm. The skin was undermined on either side. No evidence of conjunctiva or cornea was found. The incised tissue had a fibro-fatty character. A small piece was excised and sent for histopathological study, which showed fibro-fatty tissue and striated muscle fibres [Figure - 2].
| Discussion|| |
The presence of muscle tissue in the section [Figure - 2] shows that orbicularis oculi was developed, but other lid structures were missing.
As a general rule the anterior segment of the globe is disorganised, in these cases the ectatic cornea being replaced in whole or in part by fibrous tissue blended with the skin (Duke-Elder, 1964). On exploration, this case showed only fibro-fatty tissue, which suggests that the anterior segment was disorganised. It was obvious, therefore, that any attempt at surgical amelioration of the condition was impossible.
This case belongs to the first type of cryptophthalmos (ablepharon by agenesis) as all the palpebral structures were missing and there was no scar tissue to indicate an inflammatory origin.
| Summary|| |
A case report of congenital bilateral cryptophthalmos with associated cleft palate is reported with clinical and histological studies.
| Acknowledgement|| |
Our thanks are due to Dr. P. N. Dubey, Professor of Anatomy and Dr. R. V. Junnarkar, Professor of Pathology, Medical College, Nagpur for the photomicrographs and the histopathological report, respectively.
| References|| |
Calan, J. S. (1964): Recent Advances in Surgery: 6th Edn. Lon., J. & A. Churchill.
Duke-Elder (1964): System of Ophthalmology. Vol. 3 Pt. II. Lond., Henry Kimpton, p. 829.
Gupta and Saxena (1962): Brit. J. Ophthal. 46: 629.
Mann, Ida. (1957): Developmental Abnormalities of the Eye. Lond.. Brit. Med. Assn., p. 372.
Pahwa. J. M. (1960): Proceedings of the All India Ophthalmological Society Vol. XIX. p. 64.
[Figure - 1], [Figure - 2]