This newborn boy was referred by the paediatrician because of the above appearance.

a. What is the diagnosis?
 

Bilateral upper lid coloboma

Coloboma of the eyelids can be found in both the upper and lower eyelids but the most common site is the nasal half of the upper lid. There may be associated congenital lesions such as dermoids or dermolipoma.
 

b. How would you manage the patient?

It is important to examine the ocular structures for any associated lesions which may threaten visual development.

Urgency of treatment is determined by the presence of corneal exposure. In the absence of corneal exposure, the defect can be closed when the child is older as this would provide more lid tissue for closure.

Most colobomas can be closed through an end-to-end anastomosis, in larger defect additional tissue can be obtained by performing lateral cantholysis to obtain horizontal relaxation.

Lid sharing procedure in which the lower lid is used to provide tissue for the upper lid should be avoided in children due to the risk of occlusion amblyopia.