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Impressum
Severe eyelid anomalies caused by amniotic bands - a case report
Marx W., Klüppel M., Sundmacher R.
Eye Hospital, University, Moorenstr. 5, 40225 Düsseldorf
Background: Amniotic bands are known to occur in 1-2% of malformed
infants and the incidence is estimated at 1/1,300 to 1/15,000 pregnancies.
Amniotic bands have been suggested to be an occasional cause of isolated
eyelid and ocular defects. If there are no characteristic systemic anomalies
or if amniotic bands are missing, this caused relationship is difficult
to prove, however.
Patient: A one week old boy from Turkey was administered to our
hospital with many scary changes in his face. They were diagnosed as amnion
streaks. On the right side we could see cicatrized and shortened eyelids
with moderate ectropion of both the upper eyelid and more extensively
the lower eyelid. The lid margin reached just below the eyebrow. Only
a few short eyelashes were found in a massive swollen lower eyelid. The
cornea and the rest of the eye were normal. On the left side, no ocular
or eyelid malformation was noticable. No other systemic maformation was
found.
Methods: After one month with intensive corneal care, the edema
of the lower eyelid was reduced. In a first step upper eyelid reconstruction
was done. After complete lysis of the cicatrized skin and preparation
of the orbicularis muscle the skin defect was covered with a free skin
graft from behind the ear. In the next two months a scary shortening of
the upper eyelid and an insufficient parental compliance led to an ulcer
e lagophthalmo. So a second operation with preparation of the scarred
area and covering of the skin defect with a free skin graft from behind
the other ear was performed for reconstruction of the lower eyelid.
Results: After wound healing a complete closure of the eyelid with
good function of the levator muscle was observed. The corneal ulcer healed
with scar formation.
Conclusion: Amniotic bands can lead to extensive isolated eyelid
defects. With two separated procedures a good position and function of
the eyelids could be achieved in this case.