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INTRODUCTION Telecanthus refers to an abnormally wide separation of the medial canthi, with a normal interpupillary distance. The nasal bones are typically normal. This is in contrast to hypertelorism in which there is an increase in the interpupillary distance. The condition can be congenital, where it may be associated with other developmental anomalies such as the Blepahrophimosis syndrome, Toriello-Carey syndrome, Blepharo-naso-facial syndrome, Knobloch syndrome, Short syndrome, Smith-Magenis syndrome, and others. Telecanthus can also be an acquired condition resulting from high mid-facial fractures or midline craniofacial lesions such as frontoethmoid meningoencephaloceles.
CLINICAL CHARACTERISTICS Clinically the eyes as measured by the interpupillary distance are spaced normally apart, but the nasal bridge distance between the medial canthal angles is wide. As a result the eyes may appear somewhat esotropic since the amount of visible medial sclera is less than that laterally. In congenital forms of this anomaly there are associated findings such as ptosis, epicanthus, ocular abnormalities, abnormal ears, nasal defects, arched palate, etc., depending upon the specific syndrome. In traumatic telecanthus there may be associated palpable bony fractures or a soft tissue medial canthal angle dystopia, and the horizontal displacement of the canthal angle may be unilateral or bilateral. With traumatic telecanthus there may be associated lacrimal drainage dysfunction.
TREATMENT Surgical management by transnasal wiring, screw or miniplate fixation will improve telecanthus. This may be performed for either bilateral or unilateral conditions. For congenital cases repair of associated deformities may require additional procedures. In traumatic telecanthus, early primary repair gives the best chances for a good functional and cosmetic result. Associated injuries, such as to the eyelids and lacrimal drainage systems, can be repaired at the same time.
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