Centurion syndrome

Overview

Centurion syndrome is a rare congenital condition characterized by the abnormal anterior (forward) displacement of the medial canthal tendon, which leads to a prominent epicanthal fold and inward turning of the lower eyelids (epiblepharon). This anatomical variation causes the lacrimal puncta (tear duct openings) to be displaced away from their normal position, often resulting in excessive tearing (epiphora) and chronic irritation. The condition is named for the resemblance of the facial features to the helmets worn by Roman centurions.

Causes

Centurion syndrome is believed to result from a congenital malposition of the medial canthal tendon. While the exact genetic or developmental factors remain unclear, it is typically a non-syndromic, isolated finding. It may be present at birth or become more noticeable in early childhood. Unlike other forms of epiblepharon, Centurion syndrome is distinguished by the structural displacement of the tendon rather than simple redundant skin or muscle folds.

Symptoms

The hallmark features and symptoms of Centurion syndrome include:

• Epiphora: Constant tearing due to misdirected tear drainage

• Medial canthal tendon displacement: Resulting in a pulled appearance of the inner eye corner

• Epiblepharon: A condition where the eyelid margin and eyelashes turn inward toward the eyeball

• Ocular irritation: Including redness, itching, or foreign body sensation

• Cosmetic concerns: Due to altered eye shape or noticeable asymmetry

In some cases, the misalignment may predispose to secondary infections of the eye or tear drainage system if left untreated.

Diagnosis

Diagnosis of Centurion syndrome is based primarily on clinical evaluation by an ophthalmologist or oculoplastic surgeon. Diagnostic steps may include:

• Physical examination: Noting the characteristic displacement of the medial canthal tendon and eyelid configuration

• Tear drainage assessment: Including dye disappearance test or lacrimal irrigation to evaluate tear flow

• Ophthalmic imaging: May be used to assess the lacrimal system in complex or recurrent cases

• Differentiation: From other causes of epiphora or congenital eyelid anomalies such as congenital nasolacrimal duct obstruction or simple epiblepharon

Treatment

Treatment of Centurion syndrome is surgical and aims to correct the anatomical misalignment that causes tearing and irritation. Common procedures include:

• Medial canthal tendon repositioning: The primary surgical correction to restore normal eyelid anatomy

• Epiblepharon correction: May be performed simultaneously to redirect misaligned eyelashes

• Dacryoplasty or lacrimal surgery: If tear duct obstruction is also present

• Postoperative care: Includes topical antibiotics, lubricants, and regular follow-up to ensure proper healing and function

Early surgical intervention can effectively eliminate symptoms and prevent complications such as chronic conjunctivitis or corneal irritation.

Prognosis

The prognosis for individuals with Centurion syndrome is excellent with timely and appropriate surgical treatment. Most patients experience complete resolution of symptoms such as tearing and discomfort. Cosmetic appearance and eyelid function are typically restored to normal. Recurrence is rare when the underlying tendon displacement is adequately corrected. Long-term follow-up is generally not needed unless other ocular conditions are present.