|Year : 1981 | Volume
| Issue : 1 | Page : 41-42
GC Baijal1, ML Agarwal1, BD Chaurasia2
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
G C Baijal
14-C, J-A. Hospital Campus, Gwalior-474009
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baijal G C, Agarwal M L, Chaurasia B D. Unilateral cryptophthalmos. Indian J Ophthalmol 1981;29:41-2
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 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.,,,,,, [8, Cryptophthalmos is usually bilateral. In Francois[ review, there were only five reported cases of the unilateral cryptophthalmos. The present case in this regard is interesting being unilateral.
| Case report|| |
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|| |
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 reviewed the possible pathogenetic mechanisms resulting in cryptophthalmos, although none of them is entirely satisfactory. The proposed theories (DukeElder. Francois) 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|| |
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.
| References|| |
Francois, J., 1965, Ophthalmologica. 150: 215.
Sugar, H.S., 1968, Amer. J. Ophthalmol. 66: 897.
Dada, V K. and Agarwal, L.P., 1969, Orient. Arch. Ophthalmal. 7 : 126.
Parmar, I.P.S., Chandra, P. and Singh, I., 1972, Orient. Arch. Ophthalmol. 10 : 273.
Singh, N., 1973, Antiseptic. 70: 125.
Das, B. 1974, Ind. J. Ophthalmol. 22 : 24
Waring, G.O. and Shields, J.A., 1975, Amer J. Ophthalmol. 79 : 437.
Sen, S.C., 1977, Ind. J. Ophthalmol. 24 : 29
Duke-Elder's, 1963, System of Ophthalmology.Vol. 3, Part 2, p. 832, Henry Kimpton, London.
Gupta, G.P. and Gogi, R., 1981, Ind. J.Ophthalmal. 28 :231.
[Figure - 1]