Photoclinic: Euryblepharon

During a neurologic evaluation for seizures, a 17-year-old boy with epilepsy was noted to have a deformity of both lower eyelids. According to the boy's mother, the deformity had been present since birth; it was not related to the patient's neurologic condition.  The patient had normal bilateral vision, but he experienced a burning sensation and tearing bilaterally when staring at an object. Aaron Provance, MD, of Morgantown, WVa, and Atiya Khan, MD, of Fort Wayne, Ind, diagnosed euryblepharon--a rare congenital anomaly of the palpebral fissure in which excess horizontal eyelid length and decreased vertical eyelid skin cause the eyelids to pull away from the orbit. The resulting appearance may be mistaken for congenital ectropion. The lower eyelids are usually involved, but all 4 eyelids can be affected. In patients with euryblepharon, the eyelid does not oppose the lateral aspect of the globe and conjunctiva; therefore, there is no risk of exposure keratitis. Eye tearing and burning are associated symptoms. Euryblepharon may result from congenital hypoplasia or the absence of the palpebral and lacrimal portions of the orbicularis oculi muscle.1 Euryblepharon may be associated with other ocular anomalies, such as lateral displacement of the proximal lacrimal drainage system, telecanthus, congenital ptosis, and strabismus.2-5 It may occur concurrently with congenital cleft lip, oligodontia, ectropion, and lagophthalmos in blepharo-cheilo-dontic syndrome. Nonocular defects associated with euryblepharon include hypospadias, inguinal hernias, flattening of the bridge of the nose, and dental anomalies. Euryblepharon can be surgically corrected.6 This patient declined treatment. REFERENCES: 1. Keipert JA. Euryblepharon. Br J Ophthalmol. 1975;59:57-58. 2. Yen MT, Lucci LM, Anderson RL. Management of eyelid anomalies associated with blepharo-cheilo-dontic syndrome. Am J Ophthalmol. 2001;132:279-280. 3. Guion-Almeida ML, Rodini ES, Kokitsu-Nakata NM, Bologna-Amantini D. Blepharo-Cheilo-Dontic (BCD) syndrome: report on four new patients. Am J Med Genet. 1998;76:133-136. 4. D’Esposito M, Magli A, Del Prete A. Genetic study and surgical correction of euryblepharon. Ophthalmologica. 1979;178:396-403. 5. Gupta AK, Saxena P. Euryblepharon with associated ocular anomalies. J Pediatr Ophthalmol. 1976;13:163-164. 6. McCord CD Jr, Chappell J, Pollard ZF. Congenital euryblepharon. Ann Ophthalmol. 1979;11:1217-1224.