Congenital upper lid eversion and severe chemosis in a new born

Abstract

The purpose of this study is to report a case of bilateral congenital eversion of the upper eyelid in an 8 h- old male baby. JD is an 8 h-old male baby born by normal vaginal delivery after prolonged labor, to a 24-year-old primigravida. Pregnancy was said to be term but was complicated by pregnancy-induced hypertension. A midwife delivered the baby and it was by spontaneous vertex delivery. He was said to have cried immediately after birth, but shortly afterward parents noticed a reddish fleshy swelling over the eyes and this made it difficult for them to see the eyeballs. The reddish swelling steadily increased in size necessitating their prompt referral to our center. On examination, a full term baby was seen with complete eversion of both upper eyelids and marked conjunctival chemosis. Ocular examination revealed normal globes with healthy cornea and briskly reactive pupils. The child was admitted and started on 3-hourly chloramphenicol ointment, ciloxan eye drop (ciprofloxacin hydrochloride United States Pharmacopeia equivalent to ciprofloxacin 0.3% w/v) - 8 times daily and 5% hypertonic saline patch over the chemosed conjunctiva. The pediatrician was also invited to co-manage the patient. After 9-days of treatment, the conjunctival chemosis fully resolved and lids reverted back to normal position. At 4-week follow-up, the lids continued to maintain their normal position and child could now open eyelids spontaneously. Congenital upper eyelid eversion is a rare clinical entity even though it is said to be commoner in blacks. Knowledge of its complete resolution with conservative management will help in future management of such cases thereby preventing complications that may arise from poorly treated cases.

Congenital bilateral upper lid eversion

“…Our two cases were postterm. However, the role of multiparity as well as postmaturity on the occurrence of CBULE has been questioned and remains ambiguous,[ 28 ] with cases occurring from the first pregnancy[ 17 22 ] and preterm infants. [ 23 ] Parity of the mother and maturity of the baby may be coincidental findings rather than predisposing factors.…”

“…It is unlikely that delivery method can be a predisposing factor, as similar cases have been documented following both normal vaginal delivery[ 10 13 14 15 16 18 20 22 24 25 ] and cesarean section. [ 10 17 21 29 ] Mechanical eversion of the eyelids during passage through the birth canal has been suggested as a cause of CBULE. [ 15 ] However, no definitive evidence has been presented of an association between CBULE and the duration of labor or mode of delivery.…”

“…Apart from the pronounced appearance (such as bilateral prolapse), the eyes were normal, with the need to retract the edematous conjunctiva to perform an ophthalmic examination. The conjunctival chemosis appears to protect the cornea from exposure, and hence, corneal complications are rare,[ 8 17 25 ] except in cases of Down syndrome. [ 7 ]…”

“…The vast majority of reported cases in healthy children were described in Africans[ 10 11 12 13 14 15 16 17 18 19 ] or Afro-Americans[ 20 21 22 23 ] except one Arabian patient,[ 24 ] two Indian patients,[ 25 26 ] and one Turkish patient. [ 27 ] This entity is likely only encountered by few ophthalmologists throughout their career, making it important to report the clinical characteristics, feasible etiologies, and treatment options for CBULE to raise awareness and a correct diagnosis.…”

Conservative Management in Congenital Bilateral Upper Eyelid Eversion

“…Conservative management includes applying moist dressings, eyelid taping, and pressure patching along with topical antibiotic and lubricants. Additionally, topical 5% hypertonic saline has been employed as a conservative treatment by some authors [ 7 , 8 ]. The mechanism by which the 5% hypertonic saline-soaked gauze dressing worked as explained by Adeoti et al [ 7 ] is the osmosis of fluid from the oedematous tissues through the semipermeable subconjunctival membrane.…”