130004 Migratory dark without pressure: potential inflammatory marker in paediatric uveitis

We present a case series of three patients who underwent treatment for epiblepharon which developed secondary to paediatric glaucoma.Case 1 had bilateral congenital glaucoma with left buphthalmos, who required early Baerveldt glaucoma drainage device implantation for intraocular pressure control.Axial length progressed from 22.51 to 24.51 in right eye and from 23.90 to 26.39 in left eye.He subsequently developed left lower eyelid epiblepharon, causing inferior corneal pannus, and was managed surgically with modified Hotz procedure.Case 2 presented with bilateral congenital cataracts, developing secondary glaucoma after lensectomy in early life.Axial length progressed from 23.24 to 26.1 mm (right eye) and from 23 to 24.67 mm (left eye).Bilateral epiblepharon was later noted and surgery with modified Hotz procedure is planned.Case 3 had microphthalmia and bilateral congenital cataracts treated in early childhood with lensectomy, resulting in secondary glaucoma.As glaucoma became established, axial length growth to 22.49 mm (right eye) and 21.44 (left eye) was observed.She developed bilateral epiblepharon, managed with a modified Hotz procedure bilaterally.Progressive axial elongation in paediatric glaucoma may cause tension on the lower eyelid, disrupting the balance between anterior and posterior lamellae, predisposing to epiblepharon.In our series, all patients demonstrated axial length progression.One patient had a glaucoma drainage device, possibly contributing to increased orbital volume and pressure on inferior tarsus.Children with congenital glaucoma and buphthalmos should be closely monitored for the development of epiblepharon, which can lead to severe keratitis if left untreated.