Re-Examining the Tarsal Kink Syndrome: Considerations of its Etiology and Treatment

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ABSTRACT

A severe corneal ulceration that is evident shortly after birth and persists in spite of adequate medical therapy, may be secondary to a congenital entropion. A vertically kinked tarsus is an unusual and frequently overlooked form of congenital entropion. Prompt recognition of this entity is essential to avoid severe corneal injury and amblyopia.

We present a technique of tarsal stabilization which corrected this upper lid deformity in one case.

Congenital entropion with persistent corneal ulceration is not common. We present a case of severe congenital entropion caused by a vertically kinked tarsus. Although the etiology of the lid malformation is not known, we postulate various environmental causes. The promptness of the correct diagnosis and treatment in preventing serious corneal injury and amblyopia is emphasized. We describe a simple method for correcting the lid deformity that was effective in one case.

SURGICAL PROCEDURE

When the patient was examined under general anesthesia, the pleat in the superior tarsus persisted. There was a rigid angulation of the tarsus. When the lid was everted, a horizontal groove was evident (Figure 1).

The rigidly inverted lid margin was pulled off the cornea with three 6-0 black silk double-armed sutures placed inferior to the tarsal kink from the conjunctival surface, exiting via the skin superior to the upper border of the tarsus, and tied over cotton bolsters (Figure 2). The lid was stabilized with a 4-0 black silk double-armed suture as a small lateral temporary suture tarsorraphy (Figure 3).

CASE HISTORY

Following a forceps delivery, a full-term infant was noted to have a red right eye. He was treated with topical neosporin drops. When he was one week old, he was hospitalized with a corneal ulcer of his right eye. Corneal scrapings showed polymorphic mononuclear neutrophils and monocytes, but no organisms. Cultures grew few staph aureus and staph epidermidis. Viral cultures were negative. He was treated with topical neosporin, gentamycin, scopolamine, and oral erythromycin while hospitalized. He improved and was discharged after 10 days on the same medications.

He was rehospitalized one week later at age 24 days, with periorbital edema and conjunctival discharge in spite of continued systemic and...