Sir,

Eyelid imbrication syndrome is a rare cause of congenital eyelid malposition characterised by overriding of the upper eyelids on the lower lids.1 In the adult, eyelid imbrication is usually associated with floppy eyelid syndrome, and is managed by surgical tightening of the upper lid.2 In children, eyelid imbrication is extremely rare with only a single previously reported congenital case.1 Here, we describe a second case of congenital eyelid imbrication in an otherwise healthy neonate presenting with overriding upper lids on eyelid closure and also spontaneous upper lid eversion.

Case report

A full-term newborn male of Indian origin was referred 48 h postpartum with sticky eyes and apparent ‘entropion’ of both lower eyelids. The pregnancy and birth were unremarkable apart from minimal olighydramnios noted at 20 weeks gestation. Ocular examination of the child asleep showed elongated upper lids and tarsal plates overlapping the lower lid margins by more than 1 mm (Figure 1). Horizontal and mid-point vertical dimensions of the upper lids were 25 and 8 mm respectively. In addition, the upper eyelids were ‘floppy’ and could be everted with minimal effort or did so spontaneously with forceful orbicularis oculi contraction. The subtarsal conjunctiva showed minimal hyperaemia and few papillae. Conjunctival swabs showed no microbial growth. The patient was managed with topical lubricants and antibiotic prophylaxis. At 2 months postpartum there was marked improvement in lid position with reduced overriding and absence of spontaneous eversion.

Figure 1
figure 1

A newborn neonate with bilateral eyelid imbrication syndrome. Large and elongated upper lids/tarsal plates overlapped the lower lid margins by over 1 mm. The upper eyelids were ‘floppy’ and could be everted with minimal effort or did so spontaneously with forceful orbicularis oculi contraction.

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Comment

Eyelid imbrication is typically acquired in adults over the age of 40, with only one previous report of the condition in a neonate.1, 2 Here we describe a second congenital case, which in addition displayed spontaneous upper lid eversion on forceful contraction of orbicularis oculi. This striking feature is reminiscent of floppy lid syndrome, and was notably absent from the case reported by Rumelt et al.1 In both cases of congenital imbrication, natural resolution occurs with apparent tightening of the upper canthal ligaments. Congenital eyelid imbrication syndrome is thus an unusual, apparently isolated and transient eyelid abnormality, which resolves within the first few months of age. Surgical management of this condition is not required.