title: Congenital horizontal tarsal kink: a single-center experience with 6 cases.
abstract: OBJECTIVE
  To describe the clinical features, surgical management, and outcome of congenital horizontal tarsal kink.
  
  
  METHODS
  Single-center retrospective interventional case series.
  
  
  METHODS
  Six patients with congenital horizontal tarsal kink.
  
  
  METHODS
  Medical records of all patients with congenital horizontal tarsal kink of the upper eyelid managed at a tertiary care referral center were retrospectively reviewed. The referral diagnosis, presenting clinical features, associated ocular abnormalities, and outcome of entropion surgery were analyzed. Surgical treatment consisted of transconjunctival horizontal tarsotomy with marginal rotation.
  
  
  METHODS
  Evaluation of clinical presenting features and surgical correction of entropion.
  
  
  RESULTS
  Six patients were diagnosed with congenital horizontal tarsal kink. Five of 6 (83%) patients were males. The referral diagnosis was congenital entropion in 2 (33%) patients. Corneal opacity or infiltrate was the commonest associated presenting symptom, seen in 5 of 6 (83%) patients. Absence of upper eyelid crease as compared with contralateral eye was noted in all 6 (100%) patients. The tarsal kink was severe with an acute angle (defined as inability to visualize the inverted upper eyelid margin) in 4 (67%) patients that presented within 8 weeks of birth. The tarsal kink was mild with an obtuse angle (easy visualization of upper eyelid margin) in 2 (33%) patients that presented late, at 3 and 5 years of age. Transconjunctival horizontal tarsotomy with marginal rotation resulted in permanent correction of entropion (mean follow-up, 43.3 weeks; range, 16-89 weeks) in all patients. Visual acuity remained subnormal in 5 of 6 (83%) patients.
  
  
  CONCLUSIONS
  The diagnosis of congenital horizontal tarsal kink was suspected only in one third of patients at referral. Associated corneal scar or infiltrate was seen in 83% of cases, and absent eyelid crease in all cases. Congenital horizontal tarsal kink was severe in patients who presented early (within 8 weeks of birth), and mild in patients who presented late. An absent upper eyelid crease, corneal opacity at birth, and nonvisibility of upper eyelid margin are important diagnostic clues to identify this rare disorder. Transconjunctival horizontal tarsotomy with marginal rotation corrected the entropion in all patients. Visual acuity remained subnormal in 83% of patients owing to corneal opacity.
authors: Division of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, LV Prasad Eye Institute, Hyderabad, India. milind@lvpei.org
authors: Milind N
authors: MN
authors: Naik
authors: Santosh G
authors: SG
authors: Honavar
authors: Anirban
authors: A
authors: Bhaduri
authors: John V
authors: JV
authors: Linberg
mesh_terms: D002675:Child, Preschool; D003316:Corneal Diseases / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D004774:Entropion / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D005143:Eyelids / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies