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June 1991

Pressure Patch Treatment for Congenital Upper Eyelid Eversion

Arch Ophthalmol. 1991;109(6):767-768. doi:10.1001/archopht.1991.01080060021009

To the Editor.  —Congenital upper eyelid eversion is a rare disorder of unknown etiology. The condition is typically bilateral, with a higher incidence observed in black newborns, infants with trisomy 21, and children of multiparous mothers.1-3 Proposed pathophysiologic mechanisms of this anomaly include failure of the orbital septum and levator aponeurosis to fuse, orbicularis muscle hypotony, vertical shortening of eyelid skin, vertical elongation of posterior eyelid structures, and canthal abnormalities.2,3 Although the condition is self-limited, complications of conjunctival desiccation, progressive chemosis, and secondary infection are relative contraindications to waiting several weeks for spontaneous resolution. Conservative treatment of lid eversion by applying moisture chambers or topical lubricants can take weeks to months for resolution; taping the eyelids closed is technically difficult and often unsuccessful. Instead, most recently published reports recommend early surgical treatment, such as suture tarsorrhaphy, skin grafting, horizontal lid shortening, and full-thickness sutures applied between the superior

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