Vol. 102, No.4 Letters to the Journal 539

Marginal Eyelid Laceration at Birth

David Sachs, M.D.,Peter S. Levin, M.D.,and Kevin Dooley, M.D.Department of Ophthalmology, Mt. Zion Hospital(D.S.), San Francisco; and Department of Ophthal­mology, Pacific Presbyterian Medical Center (P.S.L.and K.D.), San Francisco.Inquiries to Peter S. Levin, M.D., Department of Oph­thalmology, Pacific Presbyterian Medical Center, SanFrancisco, CA 94115.

Birth injury to the eye or its adnexa has beenestimated to occur in 12% to 25% of normalbirths.V Retinal hemorrhage, corneal edema,and rupture of Descemet's membrane are themost frequent ocular injuries. Birth injury tothe eye only rarely causes permanent sequelae.

Although insults to the adnexal structures ofthe eye are usually confined to insignificantecchymoses and edema, adnexal injuries canbecome more important and thus, require in­volvement of the ophthalmologist. These seri­ous complications of delivery include orbitalhemorrhages with proptosis, injuries to theextraocular muscles, fractures of the orbit, dis­location of the globe outside the eyelids;' ever­sion of the eyelids," and blepharoptosis."

To this group of significant adnexal injuriesaccompanying delivery, we add the report of afull-thickness eyelid laceration involving theeyelid margin.

A 3280-g boy was born to a gravida 3, para 1woman. Fetal monitor showed distress and de­livery occurred in the hospital bed, but outsidethe delivery suite. A midline episiotomy wasperformed to facilitate delivery of the head.Upon birth, a 10-mm freshly cut laceration ofthe upper eyelid margin was observed (Figure).The eyelid tissues were easily apposed at thetime of surgical repair on the same day. Notissue defect or eyelash abnormality suggesting

Figure (Sachs, Levin, and Dooley). Full-thicknesslaceration of upper eyelid present at birth (arrow).

a colobomatous lesion was present. Remainingresults of the ocular and facial examinationwere normal. Postoperative eyelid function andcosmesis are excellent.

Full-thickness marginal eyelid laceration hasnot, to the best of our knowledge, been report­ed as a birth injury. The sharp edges of thewound suggest that the episiotomy scissorsengaged the upper eyelid tissue, although ex­actly how this occurred is uncertain. The cor­nea was, most likely, protected by the blunt tipof the scissors and by retropulsion of the globe.

The indications for episiotomy are debatedbecause of maternal morbidity, but not becauseof risk to the infant." Our case demonstratesthat full-thickness eyelid laceration is a poten­tial complication of vaginal delivery with episi­otomy.

References

1. Duke-Elder, S., and MacFaul, P. A.: Injuries.Mechanical Injuries. In Duke-Elder, S. (ed.): Systemof Ophthalmology, vol. 14, pt. 1. St. Louis, C. v.Mosby, 1972, pp. 9-18.

2. Jain, 1. S., Singh, Y. P., Grupta, S. L., andGupta, A.: Ocular hazards during birth. J. Pediatr.Ophthalmol. Strabismus 17:14, 1980.

3. Gershanik, J. J., and Baucum, R. W.: Primarycongenital eversion of the eyelids. Am. J. Dis. Child.127:243, 1974.

4. Crawford, J. S.: Ptosis as a result of trauma.Can. J. Ophthalmol. 9:244, 1974.

5. Thacker, S. B., and Banta, H. D.: Benefits andrisks of episiotomy. An interpretative review of theEnglish language literature, 1960-1980. Obstet. Gy­necol. Surv. 38:322, 1983.

A New Clamp for CicatricialEntropion Surgery

Geoffrey J. Gladstone, M.D.,Allen M. Putterman, M.D.,and James Karesh, M.D.Department of Ophthalmology, Sinai Hospital ofDetroit (G.J.G.), Department of Ophthalmology,University of Illinois Eye and Ear Infirmary andMichael Reese Hospital (A.M.P.), and Departmentof Ophthalmology, University of Maryland (J.K.).Inquiries to Geoffrey J. Gladstone, M.D., 29275 North­western Highway, Suite 100, Southfield, MI48034.

Cicatricial entropion is the inward turning ofthe eyelid margin. It is the result of shrinkageof the internal lamellae of the eyelid. Causes