Coloboma - External and Internal Eye
Synopsis

The embryonic fissure develops as an invagination of the optic vesicle and leaves a gap inferonasally to allow the entrance of the hyaloid artery. Fusion begins at the equator and then proceeds anteriorly and posteriorly. As such, colobomas are often found inferonasally and either in the anterior structures or posterior structures of the eye. This process is complete by the fifth week of gestation. Other relevant etiologic factors include nutrition and environmental exposure. Rat fetuses made deficient in retinol (Vitamin A) fail to close the optic fissure; this was prevented by supplementing with retinol. Colobomas can also be seen in children with fetal alcohol syndrome. Genetically, the regulation of globe development is complex. Recently, zebra fish deficient in FGF-Ras pathway components have been shown to develop ocular colobomas. Colobomas have been seen to demonstrate autosomal dominant, autosomal recessive, and X-linked inheritance in family studies.
Some syndromes associated with eye colobomas include CHARGE syndrome, cat eye syndrome, Patau syndrome, and Treacher-Collins syndrome. Occasionally, colobomas co-present with microphthalmos, a condition in which one or both eye(s) is abnormally small.
Colobomas of the eyelid are also holes in orbital structures, but arise from failure of fusion of epidermal progenitor cells, not components of the choroid fissure. Colobomas of the upper eyelid in particular can result in severe exposure keratopathy in infants. They can be seen as a component of the Fraser or Goldenhar syndromes.
Codes
Q13.0 – Coloboma of iris
SNOMEDCT:
93390002 – Congenital ocular coloboma
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