Reconstruction of Bilateral Upper Eyelid Colobomas Using a Vertical Temporal Advancement Flap

A male infant born at full term presented with bilateral upper eyelid colobomas, absent upper puncta, and fusion of the eyelids to the globes. He was admitted for management of bilateral exposure keratopathy and a central corneal ulcer in the right eye. Further examination revealed multiple congenital abnormalities, such as penile torsion, unusual hair growth pattern on the forehead, bifid nasal tip, and hypertelorism. Genetic testing confirmed a diagnosis of Manitoba oculo-tricho-anal syndrome. Because conservative management of the ocular surface was insufficient, bilateral upper eyelid reconstruction surgery was performed 5 days after birth using a vertical temporal advancement flap. At 6-month follow-up, there was excellent eyelid movement and closure with no corneal exposure. This case report describes the clinical findings of a rare bilateral upper eyelid defect and shares an innovative reconstructive technique that readers could mimic if presented with similar congenital upper eyelid defects.