Surgical Management of Severe Conjunctival Edema From Ectropion in a 3-Year-Old Collodion Baby

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Surgical Management of Severe Conjunctival Edema From Ectropion in a 3-Year-Old Collodion Baby

Collodion baby is an extremely rare congenital condition—affecting just 1 in 100,000 to 300,000 newborns—where infants are born covered in a tight, cellophane-like membrane. The membrane typically peels off within weeks, but the inelastic, scaly skin left behind often causes complications like ectropion (outward-turned eyelids), eclabium (outward-turned lips), or restricted joint movement. For one 3-year-old boy, worsening ectropion led to severe conjunctival edema (swollen eye membranes) that threatened his vision—until a surgical approach offered relief.

The Case: A 3-Year-Old With Collodion Baby-Related Ectropion

The boy was diagnosed with collodion baby at birth, later confirmed as lamellar ichthyosis (a genetic skin disorder causing thick, scaly skin) via skin biopsy. He had ectropion (outward-turned eyelids) from birth, but by age 3, the condition had escalated: his upper and lower eyelids turned outward so severely that his conjunctiva (the clear membrane lining the eyelids and eye surface) became highly swollen, forming large fluid-filled bullae (blisters).

On exam, he had no eyelashes, eyebrows, or head hair. His entire body—including his eyelids—was covered in rigid, cellophane-like skin with sparse scales and cracks. Crucially, his cornea (the eye’s clear front layer) was unharmed, but the swollen conjunctiva made it hard for him to see.

Why Surgery Was Needed

Conservative treatments (like moisturizers, eye drops, or gentle skin stretching) are the first line for collodion baby ectropion. But for this boy, conservative care wasn’t enough: the growing tension between his developing eyeball and stiff eyelids had made the ectropion so severe that his vision was compromised. Surgery was the only way to reduce the conjunctival edema and restore some sight.

The Procedure: Permanent Tarsorrhaphy

The team—led by Dr. Di Chen and Dr. Xiao-Wei Liu of the Department of Ophthalmology at Peking Union Medical College Hospital (Beijing, China)—chose permanent tarsorrhaphy, a surgery where parts of the upper and lower eyelids are sutured together to reduce tension on the conjunctiva. Here’s how it worked:

  1. Anesthesia & Prep: The boy was placed under general anesthesia.
  2. Eyelid Adjustment: The gray lines (natural folds) of his upper and lower eyelids were cut open, and the eyelid margins were cleaned (debrided).
  3. Fluid Drainage: A small incision in the upper conjunctiva released trapped fluid from the swollen membrane.
  4. Suturing: The upper and lower eyelids were stitched together with 2–3 intermittent stitches. To protect his vision, the center of the eyelids (covering the cornea) was left unsutured.
  5. Skin Protection: Silicone tubes were placed at the suture site to prevent irritation.

The Result: Reduced Edema and Improved Vision

Three months later, the stitches were removed. The conjunctival bullae had shrunk significantly, and the boy’s ability to see improved. While the ectropion wasn’t fully corrected (his eyelid skin remained too stiff), the worst of the swelling was gone—and he could use his eyes again.

Why This Matters for Collodion Baby Care

Lamellar ichthyosis is one of the most common causes of collodion baby, and ectropion is a frequent complication. For this patient, the ectropion worsened as his eyeball grew—creating more tension against his inflexible eyelids. Permanent tarsorrhaphy helped because it:

  • Reduced the outward pull on the eyelids, easing pressure on the conjunctiva.
  • Preserved vision by avoiding the cornea during suturing (critical to prevent amblyopia, or “lazy eye”).

This case adds to limited research on surgical options for collodion baby complications. While conservative care is still preferred for mild ectropion, surgery may be necessary for children where vision or quality of life is at risk.

Ethical & Consent Notes

The boy’s guardians provided written consent for his case and images to be published. Efforts were made to protect his identity, though full anonymity cannot be guaranteed.

About the Authors

This study was conducted by Dr. Di Chen and Dr. Xiao-Wei Liu of the Department of Ophthalmology, Peking Union Medical College Hospital (Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing). The work was published in the Chinese Medical Journal in 2021.

References

  1. Srivastava P, et al. Congenital ichthyosis—collodion baby case report. J Clin Diagn Res, 2016.
  2. Ozyurt BM, et al. Collodion baby case series: the success of oral retinoic acid. Turk Pediatri Ars, 2018.
  3. Panse N, Sahasrabudhe P. Ectropion in a case of collodion baby. World J Plast Surg, 2014.
  4. Bloom D, Goodfried MS. Lamellar ichthyosis of the newborn. Arch Dermatol, 1962.

doi.org/10.1097/CM9.0000000000001060

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