Vol. 102, No.

Letters to the Journal

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, San
Francisco, CA 94115.

Birth injury to the eye or its adnexa has been

estimated to occur in 12% to 25% of normal
births.V Retinal hemorrhage, corneal edema,
and rupture of Descemet's membrane are the
most frequent ocular injuries. Birth injury to
the eye only rarely causes permanent sequelae.
Although insults to the adnexal structures of
the eye are usually confined to insignificant
ecchymoses and edema, adnexal injuries can
become more important and thus, require involvement of the ophthalmologist. These serious complications of delivery include orbital
hemorrhages with proptosis, injuries to the
extraocular muscles, fractures of the orbit, dislocation of the globe outside the eyelids;' eversion of the eyelids," and blepharoptosis."
To this group of significant adnexal injuries
accompanying delivery, we add the report of a
full-thickness eyelid laceration involving the
eyelid margin.
A 3280-g boy was born to a gravida 3, para 1
woman. Fetal monitor showed distress and delivery occurred in the hospital bed, but outside
the delivery suite. A midline episiotomy was
performed to facilitate delivery of the head.
Upon birth, a 10-mm freshly cut laceration of
the upper eyelid margin was observed (Figure).
The eyelid tissues were easily apposed at the
time of surgical repair on the same day. No
tissue defect or eyelash abnormality suggesting

539

a colobomatous lesion was present. Remaining

results of the ocular and facial examination
were normal. Postoperative eyelid function and
cosmesis are excellent.
Full-thickness marginal eyelid laceration has
not, to the best of our knowledge, been reported as a birth injury. The sharp edges of the
wound suggest that the episiotomy scissors
engaged the upper eyelid tissue, although exactly how this occurred is uncertain. The cornea was, most likely, protected by the blunt tip
of the scissors and by retropulsion of the globe.
The indications for episiotomy are debated
because of maternal morbidity, but not because
of risk to the infant." Our case demonstrates
that 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.): System
of Ophthalmology, vol. 14, pt. 1. St. Louis, C. v.
Mosby, 1972, pp. 9-18.
2. Jain, 1. S., Singh, Y. P., Grupta, S. L., and
Gupta, A.: Ocular hazards during birth. J. Pediatr.
Ophthalmol. Strabismus 17:14, 1980.
3. Gershanik, J. J., and Baucum, R. W.: Primary
congenital 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 and
risks of episiotomy. An interpretative review of the
English language literature, 1960-1980. Obstet. Gynecol. Surv. 38:322, 1983.

A New Clamp for Cicatricial

Entropion Surgery
Geoffrey J. Gladstone, M.D.,
Allen M. Putterman, M.D.,
and James Karesh, M.D.

Department of Ophthalmology, Sinai Hospital of

Detroit (G.J.G.), Department of Ophthalmology,
University of Illinois Eye and Ear Infirmary and
Michael Reese Hospital (A.M.P.), and Department
of Ophthalmology, University of Maryland (J.K.).
Inquiries to Geoffrey J. Gladstone, M.D., 29275 Northwestern Highway, Suite 100, Southfield, MI48034.

Figure (Sachs, Levin, and Dooley). Full-thickness

laceration of upper eyelid present at birth (arrow).

Cicatricial entropion is the inward turning of

the eyelid margin. It is the result of shrinkage
of the internal lamellae of the eyelid. Causes