SUMMARY Ectodermal dysplasia and its related disorders may present with ocular symptoms due to involvement of the ectodermal components of the eye. This paper reports a case of congenital anhidrotic ectodermal dysplasia presenting to the ophthalmologist with epiphora due to lacrimal atresia. The embryonic origin of the lacrimal system suggests that lacrimal anomalies in association with ectodermal disorders are commoner than reports indicate. Their management consists in accurate evaluation of the anomaly followed by surgery.Various forms of ectodermal dysplasia have been reported. They mainly affect the skin and its appendages, but occasionally the ocular structures are involved as well. The commonest ocular complications reported consist mainly of corneal, lenticular, and retinal changes. This paper reports a case of anhidrotic ectodermal dysplasia associated with lacrimal anomalies.
Case reportA 12-year-old girl presented to the casualty department of the Southampton Eye Hospital complaining of epiphora, which was bilateral and present since birth. The patient had already been seen by an ophthalmologist, who diagnosed punctal atresia. Both lower lacrimal papillae were incised, which had been followed by probing. In spite of that procedure, epiphora remained constant.General examination showed the unmistakable stigmata of anhidrotic ectodermal dysplasia. These included scarcity of hair growth, particularly evident in the scalp, where the hair was scanty, brittle, and fair, with a small patch of baldness over the vertex, and receding hair line (Fig. 1). Sweat and sebaceous glands were entirely absent so that the skin was xerotic and hyperkeratotic, with hyperpigmented creases (Fig. 2). The nails were abnormal (Fig. 3), and the teeth were either absent or deformed. Her general physical development was poor and the height below average for her age.Ophthalmic examination showed very sparse eyebrows and eyelashes, the lateral two-thirds being