A 1-day-old female neonate, born of full-term spontaneous vaginal delivery, presented with gross swelling of the left upper eyelid that was noted at birth. The left eye had mucopurulent discharge with a completely everted upper eyelid (Figure 1A). The right eye showed eyelid laxity with overriding of the upper over the lower eyelid. Easy spontaneous eversion of the eyelids was noted on attempted opening. Both eyelids showed tarsal conjunctival hyperemia (Figure 1B, hatched arrows). The left upper tarsal plate was completely everted (Figure 1C, asterisk) with a grossly chemosed, ballooned tarsal conjunctiva (Figure 1C, star). On suspicion of ophthalmia neonatorum, conjunctival swabs were taken for culture but yielded negative results. The patient was diagnosed as having congenital eyelid imbrication syndrome associated with floppy eyelids. Repositioning of the prolapsed tarsal conjunctiva with patching of the left eye led to resolution. At 8 weeks of age, the imbrication resolved completely (Figure 1D), although mild residual eyelid laxity was still evident. Congenital eyelid imbrication syndrome is an extremely rare disorder that results from laxity of the eyelids and is characterized by a triad of overriding of upper eyelids, medial and lateral canthal laxity, and tarsal conjunctival hyperemia.1,2 Fewer than 10 such cases have been reported in the literature.2,3 In this instance, an uncommon clinical presentation of gross conjunctival chemosis with ocular discharge associated with eyelid imbrication syndrome closely mimicked ophthalmia neonatorum.
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