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Klin Monbl Augenheilkd 2018; 235(01): 34-38
DOI: 10.1055/s-0043-125335
Kasuistik
Georg Thieme Verlag KG Stuttgart · New York

Tarsusknickung („Tarsal Kink“): Pathognomonische Präsentation und Therapie einer seltenen kongenitalen Oberlidfehlbildung

Tarsal Kink: Pathognomonic Presentation and Therapy of a Rare Congenital Upper Eyelid Malformation
Ulrich Schaudig
Augenheilkunde, AK Barmbek, Hamburg
,
Matthias Keserü
Augenheilkunde, AK Barmbek, Hamburg
› Author Affiliations
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Publication History

eingereicht 27 November 2017

akzeptiert 07 December 2017

Publication Date:
26 January 2018 (online)

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Zusammenfassung

Hintergrund und Ziel Präsentation eines seltenen, aber typisch verlaufenden, kongenitalen Krankheitsbilds, das bei Kenntnis der pathognomonischen Zeichen unmittelbar erkannt und therapiert werden kann. Die angeborene Tarsusknickung führt zu einer Fehlstellung des Oberlids mit Entropium, die nicht übersehen werden darf, da sie unbehandelt zu einer ulzerierenden Keratitis führt.

Fall Nach Zangenentbindung bestand bei einem sonst gesunden Neugeborenen eine ausgeprägte einseitige eitrige Sekretion mit Blepharospasmus.

Differenzialdiagnose Dacryocystitis neonatorum, Neugeborenengonoblenorrhö, kongenitales Oberlidentropium mit Hornhautulkus, Tarsusknickung.

Untersuchung Bei wachem Zustand war eine vollständige Untersuchung nicht möglich. Es bestand das pathognomonische Zeichen „fehlender“ Wimpern durch die Inversion der Lidkante. Bei der Narkoseuntersuchung zeigte sich eine Tarsusknickung mit vollständigem Oberlidentropium sowie ein Hornhautulkus.

Behandlung In der Literatur werden verschiedene Methoden angegeben, um diese seltene Fehlanlage zu korrigieren. Allen gemeinsam ist die Stärkung der anterioren Lamelle, um den Knick auszugleichen. Nach Lidspaltung, Repositionierung des Tarsus und Sicherung durch Fixationsnähte heilte das Hornhautulkus rasch und folgenlos ab, Lidschluss und Lidkontur waren normal und seitengleich.

Fazit Das pathognomonische Zeichen des kongenitalen Oberlidentropiums mit Tarsusknickung ist die komplette Inversion des Lidrands, was den Eindruck „fehlender“ Wimpern vermittelt, begleitet von Blepharospasmus und im weiteren Verlauf eitriger Sekretion und Hornhautulkus. Das Krankheitsbild darf nicht übersehen werden, nur die sofortige Korrektur kann eine schwere Schädigung verhindern.

Abstract

Background Presentation of a congenital abnormality that is rare, but follows a distinct course and can be diagnosed and cured promptly if the pathognomonic presentation is recognized. A congenital tarsal kink leads to a malposition of the upper eyelid margin that must not be missed, as it will lead to ulcerative keratitis if it is not treated.

Case Presentation An otherwise healthy newborn was presented after delivery with forceps with marked unilateral purulent secretion and blepharospasm.

Differential Diagnosis Neonatal dacryocystitis, gonococcal infection, congenital entropion with ulcerative keratitis, tarsal kink.

Examination It was not possible to fully examine the lid and cornea with the baby awake. Due to total inversion of the lid margin, no lashes could be seen. Under general anesthesia, the tarsal kink, with complete inversion of the lid margin and a corneal ulcer, was confirmed.

Treatment The literature offers several methods to correct this rare malposition, all of which aim to strengthen the anterior lamella to correct the kink. After incision of the kink and repositioning of the tarsus and securing the position with fixation sutures, the ulcer healed quickly and completely; lid closure and lid contour were normal and symmetrical.

Summary Complete inversion of the lid margin is the pathognomonic sign of tarsal kink, giving the impression of “missing” lashes, accompanied by blepharospasm, followed by purulent secretion and corneal ulceration. The condition must not be misdiagnosed as only immediate correction can prevent severe damage.

Schlüsselwörter

Tarsusknickung - Lider - plastische Chirurgie - kongenitales Entropium

Key words

tarsal kink - lids - plastic surgery - congenital entropium
 

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