AI Article Synopsis
- The study examines congenital horizontal tarsal kink, focusing on its clinical features, surgical treatment, and outcomes among six patients treated at a specialized facility.
- Among the participants, most were male, and common symptoms included corneal opacity and lack of upper eyelid crease; four patients had a severe form of the condition that presented shortly after birth.
- The surgical approach used was transconjunctival horizontal tarsotomy with marginal rotation, leading to successful entropion correction in all cases, although most patients still had poor visual acuity afterward.
Article Abstract
Purpose: To describe the clinical features, surgical management, and outcome of congenital horizontal tarsal kink.
Design: Single-center retrospective interventional case series.
Participants: Six patients with congenital horizontal tarsal kink.
Methods: Medical records of all patients with congenital horizontal tarsal kink of the upper eyelid managed at a tertiary care referral center were retrospectively reviewed. The referral diagnosis, presenting clinical features, associated ocular abnormalities, and outcome of entropion surgery were analyzed. Surgical treatment consisted of transconjunctival horizontal tarsotomy with marginal rotation.
Main Outcome Measures: Evaluation of clinical presenting features and surgical correction of entropion.
Results: Six patients were diagnosed with congenital horizontal tarsal kink. Five of 6 (83%) patients were males. The referral diagnosis was congenital entropion in 2 (33%) patients. Corneal opacity or infiltrate was the commonest associated presenting symptom, seen in 5 of 6 (83%) patients. Absence of upper eyelid crease as compared with contralateral eye was noted in all 6 (100%) patients. The tarsal kink was severe with an acute angle (defined as inability to visualize the inverted upper eyelid margin) in 4 (67%) patients that presented within 8 weeks of birth. The tarsal kink was mild with an obtuse angle (easy visualization of upper eyelid margin) in 2 (33%) patients that presented late, at 3 and 5 years of age. Transconjunctival horizontal tarsotomy with marginal rotation resulted in permanent correction of entropion (mean follow-up, 43.3 weeks; range, 16-89 weeks) in all patients. Visual acuity remained subnormal in 5 of 6 (83%) patients.
Conclusion: The diagnosis of congenital horizontal tarsal kink was suspected only in one third of patients at referral. Associated corneal scar or infiltrate was seen in 83% of cases, and absent eyelid crease in all cases. Congenital horizontal tarsal kink was severe in patients who presented early (within 8 weeks of birth), and mild in patients who presented late. An absent upper eyelid crease, corneal opacity at birth, and nonvisibility of upper eyelid margin are important diagnostic clues to identify this rare disorder. Transconjunctival horizontal tarsotomy with marginal rotation corrected the entropion in all patients. Visual acuity remained subnormal in 83% of patients owing to corneal opacity.
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| http://dx.doi.org/10.1016/j.ophtha.2006.12.001 | DOI Listing |
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