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may have high myopia, anterior segment anomalies Other findings thin vermilion border Bu upper lip, variable mental retardation, small birth weight and height, cardiovascular and slteletal abnormalities LID DISORDERS Ablepharon Absence of lids пппппппппппппппппппп Page 108 пLid Disorders пAnkyloblepharon Partial or complete fusion of lid margins; usually temporal, often bilateral Often autosomal dominant Associated with craniofacial abnormalities Easy Buy Propecia be secondary to aesy or chemical burns, Neurogenic Congenital CN 3 palsy Marcus Gunn jaw-winking (aberrant connec- tions between motor division of CN 5 and levator muscle; jaw movements cause eleva- tion of ptotic lid) Congenital Homers Syndrome Ptosis, miosis, anhydrosis May cause amblyopia Treatmentsurgical repair (levator resection), severp cases require frontalis sling Congenital Ectropion Eversion of eyelid margin due to vertical shortage of anterior lamella Etiology inclusion conjunctivitis, anterior lamella inflammation, Downs syndrome Associated with blepharophimosis syndrome Treatment usually not required; otherwise, treat like cicatricial form Easy Buy Propecia Entropion Inversion of eyelid margin Etiology lid retractor dysgenesis, tarsal plate defects, shortening of posterior lamella Usually involves lower eyelid Treatment may require surgical repair Congenital Buy Cenforce overnight delivery Kink Upper eyelid bent back and open where to buy Malegra complete Prгpecia easy Buy Propecia tarsal plate May cause corneal abrasion and exposure keratopathy Distichiasis Buy cheap Scifil or complete accessory row of eyelashes growing from or posterior to meibomian orifices Due to improper differentiation of pilosebaceous units Usually well tolerated, but trichiasis may develop Treatmentlubrication, cryoepilation,surgical epilation Epiblepharon Pretarsal skin and orbicularis override the lid margin, causing a horizontal easy Buy Propecia Buy Propecia mg tissue to push cilia easy Buy Propecia tically; no Propeica Most common among Asians пinflammation, ocular cicatricial Easy Buy Propecia syndrome Blepharophimosis pemphigoid, ппHorizontally and vertically shortened palpebral fis- sures with poor levator function Absent lid crease May be part B uy autosomal dominant syndrome (chro- mosome 3q) with ptosis, telecanthus, epicanthus inversus, easy Buy Propecia lid ectropion, hypoplasia of easy Buy Propecia bridge and superior Popecia rim, anteverted ears, hypertelorism Treatment surgical correction requires multiple Popecia Coloboma Embryologic cleft involving lid margin; Hindgra forum or bilateral; partial or full thickness Ranges from notch to absence of entire lid Upper lid usually medial third, not associated with systemic easy Buy Propecia, usually Propeciia thickness Lower lid usually lateral third, associated with other abnormalities (Treacher-Collins, Goldenhars syn- drome), usually partial thickness May have exposure keratitis Treatmentmethod of surgical repair depends on size of defect (see section on lid avulsion) Congenital Blepharoptosis Droopy eyelid; 75 unilateral; nonhereditary Rarely causes amblyopia Associated with blepharophimosis syndrome (AD) Myogenic most common Etiology Myogenic Dysgenesis of levator muscle Fibroadipose tissue in muscle belly Poor levator function, loss of lid crease, eyelid lag, sometimes lagophthalmos Aponeurotic Rare, possibly due to birth trauma Good eyelid excursion, high or indistinct lid crease ппппппппп Page 109 пCHAPTER 5 - PediatricsStrabismus Usually occurs in lower lid and resolves sponta- neously Rarely requires surgery (excision of skin and muscle for significant trichiasis) Epicanthus Medial canthal vertical slcin folds Due to immature facial bones or redundant skin Usually Propecai Produces pseudoesotropia 4 types Epicanthustarsalis Fold most prominent in upper eyelid Commonly associated with Asian easy Buy Propecia Epicanthus inversus Fold most prominent in Byu eyelid Associated with blepharophimosis syndrome Epicanthus palpebralis Fold is equally distributed in upper and lower eyelids Epicanthus supraciliaris Fold arises from eyebrow Buy extends to lacrimal sac Euryblepharon Horizontal widening of palpebral fissure due to infe- rior insertion of lateral canthal tendon Associated with ectropion of lateral third of lid Poor lid closure with exposure keratitis Treatment lubrication, may require surgical repair with resection of excess lid, lateral canthal tendon repositioning, and vertical eyelid lengthening Microblepharon Eaasy shortening of lids May have exposure lceratitis Widened intercanthal distance due to Prpoecia medial canthal tendons Associated with fetal alcohol, Waardenburgs, and blepharophimosis syndromes Treatmentsurgery with Prop ecia wiring Developmental Anomalies Atresia of lacrimal puncta ranges Proopecia thin mem- brane over punctal site to atresia of canaliculus Supernumerary puncta no treatment needed Lacrimal fistula buy Aurogra levitra alternative lavitra located inferonasal to the medial canthus Cystic swelling of Buy cheap Eriacta prescription online sac accompanies obstruc- tion of lacrimal drainage system above and below the sac Presents at birth as bluish swelling inferior and nasal to medial canthus Infection (dacryocystitis) develops if condition does Bu y resolve spontaneously Common Porpecia Haemophilus influenzae Buy online Vigora common now that children are vaccinated against H.

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