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Year : 1969  |  Volume : 17  |  Issue : 4  |  Page : 163-165

Congenital epitarsus

Department of Ophthalmology and Paediatrics, G.S.V.M. Medical College, Kanpur, (U.P.), India

Date of Web Publication10-Jan-2008

Correspondence Address:
B M Varma
Department of Ophthalmology and Paediatrics, G.S.V.M. Medical College, Kanpur, (U.P.)
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Varma B M, Garg B K. Congenital epitarsus. Indian J Ophthalmol 1969;17:163-5

How to cite this URL:
Varma B M, Garg B K. Congenital epitarsus. Indian J Ophthalmol [serial online] 1969 [cited 2023 Nov 28];17:163-5. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1969/17/4/163/38538

Epitarsus is 'an apron-like fold of conjunctiva' attached to the inner tar­sal surface of the lid, the edge being free so that a probe can be passed un­derneath it for some distance. Both surfaces of this fold are covered with mucosa. It may occur in one or both lids of one or both eyes. The historical aspects have been discussed by Duke-­Elder (1964). The deformity was fully described and named by Schap­ringer (1899, 1906).

As congenital epitarsus is an extre­mely rare condition the present case is being reported.

  Case Report Top

G.D., 3-year-old Hindu male child was brought with the complaint that the appearance of the left eye was dif­ferent from that of the right since birth. There was no history of drug intake by the mother or of infection, trauma or exposure to radiation during preg­nancy. He was the product of a nor­mal full term pregnancy. The neonatal period and infancy had been unevent­ful. There was no history of sore-eyes, trauma to the eyes or of exanthematous fevers except uncomplicated measles which he had at the age of 2 years. He had been successfully vaccinated for small pox. None of the family mem­ber had any congenital abnormality or disease of the eyes.

Physical examination revealed a well nourished child. Apart from the mal­formation in the left eye no other ab­normality was detected on physical examination.

There was no abnormality in the right eye. A thin, translucent, pinkish membrane was found to be covering the anterior part of the left eyeball except in the central area, about 5 mm in diameter, through which the cornea could be seen. As the child was un­cooperative detailed examination was done under general anxsthesia. This membrane was found to extend from the medial canthus, continuous with the plica semilunaris, towards the up­per and lower fornices where it was at­tached. On the lateral side this mem­brane was attached to the conjunctiva of the lateral canthus. Thus it form­ed a complete diaphragm with a cen­tral aperture, about 5 mm. in diame­ter, with a free margin through which a probe was passed and no attach­ment of this membrane with either cornea or bulbar conjunctiva, right upto the fornices, was found [Figure - 1]. The cornea, anterior chamber, iris and pupil were normal. Funduscopy did not reveal any abnormality. There was no evidence of trachoma or any other infective disease of the conjunc­tiva.

The conjunctival smear, apart from some epithelial cells, did not show any organism or pus cells. The routine ex­amination of the urine and blood did not reveal any abnormality.

The operation was done under gene­ral anesthesia. The lids were retracted by Desmare's lid retractors and the membrane, which was loose, became taut and was incised with scissors through the central opening upto the lateral and medial canthi. Some of the redundant portion was excised and the remaining part was reposited into the fornices. The patient made an un­eventful recovery and was discharged from the hospital on the sixth post­operative day. He has been followed up for six months and has been found to be doing well [Figure - 2].

  Comments Top

The only reference to this condition in the English Ophthalmic literature which we could find is by Treacher Collins (1921) who cites Lindsay John­son as seeing a boy who had an ob­vious nictitating membrane which reached almost upto the cornea and was capable of slight movement.

The plica semilunaris in man may be looked upon as atavistic (Mann, 1957) as this represents the third eyelid or the nictitating membrane of the lower animals. Generally speaking, one finds this membrane less developed as the hand is more able to wipe the eyes (Ovio, 1927). This is well developed in the solipeds, but less in the cat. In man and in many monkeys it is ab­sent, but chimpanzees have one (Wolff).

Wibaut (1925-26) suggested that con­genital epitarsus is a primary congeni­tal malformation and is due to the persistence of hypertrophic fold of the plica semilunaris. Its occurrence in monozygotic twins (Wibaut, 1925-26; Bersiere, 1948) also supports this view. Schapringer (1899) suggested that these folds were the result of adhesions of the amniotic bands to the epithelial cover­ing of the globe while Nitsch (1927) and Taborisky (1928) thought these to be a sequel of intra-uterine conjuncti­vitis. We feel that epitarsus in the pre­sent case was congenital in origin be­cause it had been present since birth, it was continuous with the plica semi­lunaris and there were no signs of in­flammation or a previous history of such an episode.

Duke-Elder (1964) writes "that a similar deformity may be produced in postnatal life through a neglected con­junctival inflammation is seen by the fact that it is frequently found in these circumstances among Hindus (Her­bert, 1901) and Palestine Jews (Tabo­risky, 1928)". From the Institute of Ophthalmology, Aligarh (India), Singh anti Grover (1960) and Nema Nath, Ahuja and Shukla (1965) have reported cases of so-called epitarsus following mucopurulent or pseudomembranous conjunctivitis, untreated trachoma, misuse of caustics, xerophthalmia and scraping operation in the florid stage of trachoma. These are really varieties of symblepharon and not of epitarsus and in fact Shukla (cited by Singh and Grover, 1960) had suggested the term 'epitarsoblepharon' for these cases. So their plea that the term epitarsus is vague and misleading and should be discarded is not valid as is examplified by the present case.

  Summary Top

Congenital epitarsus in the left eye, reaching upto and covering the peri­pheral part of the cornea, in a 3-year­old Hindu boy is described. It has been suggested that this condition was due to the persistence of the nictitat­ing membrane. The literature con­cening its pathogenesis is reviewed.[15]

  References Top

BESSIERE, (1948) Bull. Soc. franc. OphthaI.. 61, 149.  Back to cited text no. 1
DUKE-ELDER, S.. (1964) System of Oph­thalmology, Vol. III, Normal and Ab­normal Development, Part 2, Congenital Deformities, p. 908-909, Henry Kimpton. London.  Back to cited text no. 2
HERBERT. H. (1901) Trans. ophthal. Soc. U.K.. 21, 16.  Back to cited text no. 3
MANN, I.. (1949) The Development of the Human Eye. ed. II p. 266, The British Journal of Ophthalmology Ltd., London.  Back to cited text no. 4
NEMA, H. V.. MATH, K., AHUJA, O. P. and SHUKLA. B. R. (1965) Accessory Conjunctival Folds : So-called Epitarsus. Brit. J. Ophthal.. 49, 148.  Back to cited text no. 5
NFTSCH, M., (1927) Zeits. Augenheilk.. 62, 63. cited by Duke-Elder in 2.  Back to cited text no. 6
OVIO. (1927) Anatomie et Physiologic de I' Oe it, translated by C. Dejean, Paris.  Back to cited text no. 7
SCHAPRINGER, A. (1893) Zeits. Augen­heilk., 2, 41.  Back to cited text no. 8
- (1906) Zhl. prakt. Augenheilk.. 30, 146.  Back to cited text no. 9
S1NGH, S., and GROVER, A. D., (1960) Epitarsus. and Post-inflammatory con­junctival Adhesions. A.M.A. Arch. Ophthal., (Chicago). 63, 503.  Back to cited text no. 10
TABORISKY, (1928) Klin. Mbl. Augen­heilk.. 81, 488.  Back to cited text no. 11
TREACHER COLLINS (1921) Changes in the Visual Organs with the adoption of arboreal life and with the assumption of erect posture. Trans. ophthal. Soc. U.K., 41, 10-90.  Back to cited text no. 12
WIBAUT, F. (1925) Ned. T. Geneesk.. 69 (2). 460, cited by Duke-Elder.  Back to cited text no. 13
(1926) Zeits. Augenheilk., 59, 50. Cited by Duke-Elder.  Back to cited text no. 14
WOLFF, E.: (1958) The Anatomy of the Eye and Orbit ed. 4. p. 457. H. K. Lewis Co. Ltd. London.  Back to cited text no. 15


  [Figure - 1], [Figure - 2]


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