Central corneal dellen: A complication of upper eyelid tarsotomy

Purpose: To report a rare complication of central corneal dellen that developed after a tarsotomy procedure to correct cicatricial entropion. Method: Central corneal dellen developed in a 60-year-old woman 3 months after a tarsotomy procedure for correction of cicatricial upper eyelid entropion. Eversion of the upper eyelid showed a retracted and buckled tarsal plate and the presence of a 5 × 10-mm depression between the edge of the tarsoconjunctival flap and lower tarsal bridge. Results: The recalcitrant corneal defect was reversed when the upper eyelid tarsoconjunctival surface contour was restored by full-thickness tarsal incisions designed to flatten the dome-shaped tarsal plate. Conclusion: An upper eyelid defect producing suboptimal lid - globe apposition during lid closure can lead to dellen formation because of focal corneal dehydration as the result of an altered tear meniscus.