Successful surgical management of bilateral incomplete cryptophthalmos: A stitch in time

We report the clinical features and management of a 22-day-old male infant with bilateral incomplete cryptophthalmos, born of consanguineous marriage. Examination revealed upper lid colobomas, symblepharon with superior cornea, and obliterated fornices medially and nasally, leading to severe exposure keratopathy with secondary changes in the form of corneal opacification and early keratinization necessitating an expedited definitive surgery. Systemic evaluation ruled out Fraser syndrome. The child underwent early surgical intervention with symblepharon release, amniotic membrane grafting, and staged Cutler-Beard procedures for lid reconstruction. At 7 years, he maintains good cosmetic and functional outcomes with adequate lid closure and blinking. Residual superior limbal stem cell deficiency and minor interpalpebral scarring are monitored. The child remains on intensive lubrication, with lateral tarsorrhaphy planned for persistent lagophthalmos. A timely, methodical and stepwise reconstruction of lid and ocular surface can help in preserving the useful functional vision in bilateral incomplete cryptophthalmos. It is pertinent for the ophthalmologists to be aware of this surgical intervention.