Congenital

• A rare failure of lid differentiation
• Skin over eye (no lids or palpebral fissure) that sometimes blends in with the cornea which is usually malformed.

• Often well tolerated
  • no keratopathy
• Involves primarily the upper lid

• Fusion of part or all lid margin: variant: Ankyloblepharon filiforme adnatum in which the lid margins are connected by fine strands.

• Usually involves the lower lid
• Distal part of tarsus rotated inward
• Lashes abrade the cornea causing keratopathy
• Permanent corneal damage is uncommon

• A horizontal fold of skin adjacent to either the upper or lower lid
  • More commonly the lower lid
• Tolerated well by the cornea
• Often spontaneously resolves in the first years of life
• Surgery only indicated for severe cases

• Child is born with the upper lid bent backwards often with a 180 degree fold in the upper tarsal plate
• Corneal exposure and rubbing by the bent edge can result in ulceration

• An accessory row of lashes growing from the meibomian orifices or posteriorly
• The lashes are thinner, shorter, less pigmented and frequently well tolerated

• Enlargement of the lateral part of the palpebral aperture with downward displacement of the temporal 1/2 of the lower lid.

• Crescentic fold of skin running vertically between the lids and overlying the inner canthus. There are three types:

• Normal interpupillary distance but wide intercanthal distance
  i.e. Waardenburg's syndrome
• not: Hypertelorism, which indicates increased distance between the
  bony orbits.

Blepharophimosis

• Frontalis slings are usually done early in life
• Repairing telecanthus and epicanthus which may improve with age is delaye