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Year : 2006  |  Volume : 54  |  Issue : 3  |  Page : 203-204

Congenital eversion of upper eyelids: Case report and management

Shri Ganapati Netralaya, Jalna (Maharashtra), India

Correspondence Address:
Rajat Maheshwari
Cataract, Orbit, Lacrimal and Eyeplastic Service, Shri Ganapati Netralaya, Jalna - 431 203
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.27076

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Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down's syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching.

Keywords: Congenital, eversion, upper eyelid

How to cite this article:
Maheshwari R, Maheshwari S. Congenital eversion of upper eyelids: Case report and management. Indian J Ophthalmol 2006;54:203-4

How to cite this URL:
Maheshwari R, Maheshwari S. Congenital eversion of upper eyelids: Case report and management. Indian J Ophthalmol [serial online] 2006 [cited 2022 Aug 7];54:203-4. Available from: https://www.ijo.in/text.asp?2006/54/3/203/27076

Congenital eversion of the upper eyelid was first described by Adams[1] in 1896, who called it as "double congenital ectropion". Sellar[2] in 1992, reviewed the literature and found 51 reported cases. Since then, three[3],[4],[5] more case reports could be found in the literature. The eversion is usually present at birth, but late onset of total eversion of the upper eyelid has been reported.[2] We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, delivered normally.

  Case Report Top

A 5 day old male child was seen with total eversion of both the upper eyelids since birth. The baby was born by normal vaginal delivery, without any instrumentation.

On examination, he had complete eversion of both the upper eyelids, with marked conjunctival chemosis [Figure - 1]. The lid could not be repositioned to the normal position, even with pressure. The lids were double-everted to visualize the eyeball. The cornea appeared healthy and pupillary reactions were brisk.

The child was put on hourly refresh liquigel (carboxymethylcellulose 1.0%), ciplox eye drop (ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) - 8 times, ciplox eye ointment (ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/w) - 2 times daily and was advised a follow up after one week.

At one week follow up, the condition improved and the child could open his eyes partially. The lids could be manually repositioned, but reverted back on releasing. The mother was advised to continue the same treatment and was advised to keep the lids inverted, by patching. On subsequent follow up after 2 weeks, the condition improved and the mother gave a history that the child could open his eyes intermittently, but the lids continued to evert on crying. On examination, chemosis was found to be decreased and the lids could be easily repositioned. This time, the mother was advised to patch the eyes with sterile cotton pads after repositioning the lids and to continue topical lubricants and ointments. At follow up after four weeks, the lids retained their normal position and the child could fixate and follow light. The conjunctiva was healthy and the cornea was clear [Figure - 2].

  Discussion Top

The condition is typically bilateral, but unilateral cases have been described. The underlying cause for eversion remains obscure, several possible mechanisms have been proposed and associations have been recognized. The incidence appears higher in black infants,[6] infants with trisomy 21[2] and infants born with collodion skin disease.[7] Abnormalities such as orbicularis hypotonia, birth trauma, vertical shortening of the anterior lamella or vertical elongation of the posterior lamella of the eyelid and failure of the orbital septum to fuse with the levator aponeurosis, absence of effective lateral canthal ligament and lateral elongation of the eyelid, have all been implicated as possible patho-physiological factors.[5] Venous stasis during delivery may cause marked chemosis and prolapse of the conjunctiva, causing eversion of the eyelids.[8] Once everted orbicularis spasm may act as sphincter, that leads to a vicious cycle of conjunctival strangulation and edema, secondary to venous stasis.[9] The chemosed conjunctiva protects the cornea from exposure and hence, corneal complications are rare.

Congenital eyelid eversion can be treated conservatively. The goal of management is to prevent dessication of the exposed conjunctiva and allow spontaneous inversion of the lid. Surgical treatment options include temporary tarsorrhaphy, subconjunctival injection of hyaluronic acid, fornix sutures and full thickness skin graft to the upper lid.

Our case was managed by topical lubrication, antibiotics and patching of the eyelid. This case illustrates the need for early successful repositioning of the eyelid, to break a cycle leading to increasing lid edema, conjunctival chemosis and eversion.

Congenital eyelid eversion is very rare and may present "once in a life time" to the ophthalmologist. However, it is important to note that the condition is very amenable to conservative treatment, if started early.

  References Top

Adams AL. A case of double congenital ectropion. Med Forthnight 1896;9:137-8.  Back to cited text no. 1
Sellar PW, Bryars JH, Archer DB. Late presentation of congenital ectropion of the eyelids in a child with Downs's syndrome: A case report and review of the literature. J Pediatr Ophthalmol Strabismus 1992;29:64-7.  Back to cited text no. 2
Watts MT, Dapling RB. Congenital eversion of the upper eyelid: A case report. Ophthal Plast Reconstr Surg 1995;11:293-5.  Back to cited text no. 3
Dawodu OA. Total eversion of the upper eyelids in a newborn. Niger Postgrad Med J 2001;8:145-7.  Back to cited text no. 4
Al Hussain HA, Al-Rajhi AA, Al-Qahtani S, Meyer D. Congenital upper eyelid eversion complicated by corneal perforation. Br J Ophthalmol 2005;89:771.  Back to cited text no. 5
Lu LW, bansal RK, Katz man B. Primary congenital eversion of the upper lids. J Pediatr Ophthalmol Strabismus 1979;16:149-51.  Back to cited text no. 6
Shapiro RD, Soentgen ML. Colloidin skin desease and everted eyelids. Postgrad Med 1969;45:216-9.  Back to cited text no. 7
Conlon MR, Sutula FC. Congenital eyelid anomalies. In Albert DM, Jakobiac FA (editors): Principles and Practice of Ophthalmology, vol 4, 2nd ed. WB Saunders Co: Philadelphia, PA; p. 3336.  Back to cited text no. 8
Rabb EL, Saphir RL. Congenital eyelid eversion with orbicularis spasm. J Pediatr Ophthal Strabismus 1985;22:125-8.  Back to cited text no. 9


  [Figure - 1], [Figure - 2]

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