Treacher Collins Sydrome: Treatment

The Eyes
The inferior tilt of the outside of the eyelids (an area called the lateral canthus) is best treated with an operation called a "canthopexy." This operation basically just lifts the outside of the corner of the eyes. In general, people are considered more attractive if the outside corner of their eyes is higher than the inside. In TCS, the eyes tilt downwards. By lifting up the outside corners, the child will appear to look "less sad." This operation can be done at any age, however, the younger the child is, in general, the less successful this operation is because the eyes will tend to go back to the way they were. This recurrence is because of a substance in the skin that is called elastin. Elastin works like a rubber band, it helps to keep youthful skin tight, but also "wants" to pull the corner of the eye back to where it was before surgery. As we all get older, we lose this elastin, and as a result the effects of surgery are more dramatic. At our center, this operation (a canthopexy) is typically done without putting any external facial scars on the patient.

Another operation that may be recommended is the upper eyelid switch flap. In this operation, tissues are taken from the upper eyelid and brought down to the lower eyelid. I almost never recommend this operation. The scars that are left behind (in my opinion) tend to look horrible for the rest of the child's life. Most patients that have had this procedure are very unhappy with the results, yet many doctors still recommend it to their patients. The use of skin grafts in the lower eyelids also look very bad, and tend to be ineffective, as well.