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This discussion of normal and abnormal findings on routine ophthalmic examination of the foal should prove useful to the equine practitioner who must provide counsel to the concerned owner and/or breeder. Early diagnosis and treatment of ocular abnormalities improve the prognosis for continued function and aid determination of the significance of lesions observed in later life.
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Eye growth is regulated by a precise, sharp image of a distant object on the photoreceptor layer. A variety of laboratory investigations report that translucent occluders may induce axial eye elongation in animals. This axial growth is also called form deprivation myopia (FDM). In our pediatric ophthalmology clinic we observed the clinical correlate of FDM in a male infant with unilateral corneal ulcer due to a congenital tarsal malformation. Examination in the postnatal period under anesthesia revealed identical axial length in both eyes. Refraction of the affected eye could not be measured due to severe corneal ulcer. During an observation period of two years, the deep corneal opacification of the affected eye induced unilateral disproportionate axial elongation with formation of myopia. Formation of FDM may complicate treatment of amblyopia following unilateral media opacification. Periodic measurements of refraction should be performed to allow appropriate correction.
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We have used a hard palate mucosal graft for reconstruction of the posterior lamella of the eyelid and in only one case was replacement required because of discomfort and pain. The stratum corneum of the hard palate mucosa may have been the cause.
A variety of materials have been used to reconstruct defects of the orbital floor. Autogenous materials such as bone and cartilage have the obvious drawback of the necessary donor site, whereas alloplastic implants carry the potential risk of infection, particularly when in communication with the maxillary sinus. Consequently, there has been interest in the use of resorbable alloplastic material that acts as a barrier until completely degraded. In this series, a total of 12 patients with orbital defects larger than 1 cm2 were treated by the placement of a resorbable mesh plate of polyglycolic and polylactic acid (Lactosorb). Of the total of 12 patients treated, 3 were lost to follow-up. Of the remaining 9 patients, the mean follow-up was 6 months, with the longest follow-up being 15 months and the shortest 1 month. Two patients developed enophthalmos. In each case, this measured 2 mm using Hertel exophthalmometry, and was present in the early postoperative period (less than 1 month). The cause of the enophthalmos in both patients was found to be a technical error in placement of the mesh. One patient developed an inflammatory reaction along the infraorbital rim requiring implant removal. This occurred at 7 months. From the above series, it is concluded that resorbable mesh is an acceptable material for reconstruction of the orbital floor in selected patients. It is believed that larger floor defects are better suited for nonresorbable alloplastic reconstruction, and that placement of the mesh over the infraorbital rim is unnecessary and places the patient at risk for a local inflammatory reaction.
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PURPOSE: To describe the clinical characteristics of congenital horizontal tarsal kink. METHODS: Retrospective clinical series derived from a literature review and mail survey. Characteristics included sex, race, association with systemic diseases, interval between birth and diagnosis, laterality, presence of corneal ulcer and causative infectious agent, treatment, and visual outcome. RESULTS: Twenty-five cases were reviewed. The typical patient is a white male diagnosed at 7.2 weeks of age. Right-sided and bilateral cases were most common. Ulcers were present in 12/24 patients; most were culture negative. Various methods of surgical repair were successful. Visual outcomes, in general, were favorable although amblyopia developed in 4/15 patients. CONCLUSIONS: Congenital horizontal tarsal kink is rare and its cause is unknown. A poor visual outcome usually results from a corneal ulcer scar and a delay in diagnosis. Amblyopia not related to corneal opacification can also occur.
A newborn presented with congenital severe tarsal kink of the upper eyelids not caused by levator aponeurosis disinsertion. A bilateral anterior lamellar repositioning procedure was performed to correct the tarsal kink. Levator aponeurosis disinsertion was not observed as an intraoperative finding. The tarsal kink disappeared, and eyelid positions remained stable during a follow-up period of 1 year. Our case indicates that severe congenital tarsal kink may develop without levator aponeurosis disinsertion, and anterior lamellar repositioning technique is a simple and effective method of treatment.
We describe a case of unilateral upper eyelid horizontal tarsal kink with congenital corneal ulceration. The surgical repair, by means of a simple resection of orbicularis and skin, is presented as a simple technique to correct the congenital anomaly of tarsal kink. Congenital tarsal kink should be included in the differential diagnosis of congenital corneal opacity and ulceration. Early recognition and surgical intervention reduces corneal scarring.
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Repair of the contracted eye socket with a flap from the upper eyelid is proposed. The availability of nearby tissue with good blood supply could make this a method of choice in many patients with this condition.
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The authors present a new technique for the correction of the medial epicanthal fold using the Y-W-plasty or inverted Y-V-plasty combined with plication of the medial canthal tendon. From January of 1996 to April of 2001, 10 patients with epicanthal folds received a medial epicanthoplasty combined with plication of the medial canthal tendon. The patients ranged in age from 20 to 49 years (average, 27.3 years). Eight patients with epicanthal folds received the Y-W-plasty with plication of the medial canthal tendon. Two patients were operated by inverted Y-V-plasty. The follow-up period ranged from 5 months to 2 years. Neither injury of the lacrimal apparatus nor asymmetry of the eyes was noted. Fibrosis and redness of the operated scar was noted in the first 2 to 3 months. However, the scar maturated by 3 months in all patients, and the hypertrophic scar was unnoticeable in all patients. Two key modifications of this technique are plication of the outer leaflet of the medial canthal ligament and lateral advancement of the central triangular flap. These modifications remarkably reduce the tension along the skin suture line. This method is very effective for the correction of the moderate-to-severe epicanthal fold. In addition, these modifications can be applied in most other medial epicanthoplasty techniques.