Ankyloblepharon

Ankyblephron

INTRODUCTION Ankyloblepharon is a condition where the eyelid margins are fused together to varying degrees. In congenital ankyloblepharon the fused eyelids fail to completely separate during embryogenesis. It can occur as a sporadic isolated finding or in association with diverse chromosomal and syndromic conditions characterized by failure of separation of apposed tissues suggesting a common defect in the mechanisms that regulate tissue fusion. It has also been associated with trisomy 18. The condition may be complete, partial, or interrupted. In the latter, called ankyloblepharon filiforme, multiple epithelial bands are present between the upper and lower lid margins. More commonly, in partial ankyloblepharon, the horizontal palpebral fissure is shortened. Ankyloblepahron can also be seen following trauma, chemical burs, cicatrizing diseases such as Stevens-Johnson syndrome or cicatricial ocular phemphigoid, or inflammations such as ulcerative blepharitis or herpes simplex.

CLINICAL CHARACTERISTICS In simple congenital ankyloblepharon the eyelid margins are usually fused laterally, and less commonly medially. The condition frequently accompanies other developmental anomalies such as anophthalmos, microphthalmos, ptosis, or cleft lip. In many cases the lateral canthal angle is displaced downward giving an antimongaloid slope to the palpebral fissure. The lateral canthal tendon is lax or not developed so that there is also significant laxity of the lower eyelids. In ankyloblepharon filiforme adnatum one or more narrow epithelial bands connect the central upper and lower eyelid margins. These vary from 0.5 to 5 mm in width, and may range from 1 to 10 mm in length. The zone of attachment is between the eyelashes and the meibomian gland orifices. In cases of total ankyloblepharon lacrimal secretions may accumulate beneath the lids forming a large fluid cyst. Ankyloblepahron is most commonly confused with euryblepharon since in both cases the lateral portion of the lid may be lax and displaced downward. However, in ankyloblepharon the eyelid margins are fused together for some distance giving a shorter horizontal fissure, whereas in euryblepharon the fissure is longer than normal.

TREATMENT Treatment of ankyloblepharon is surgical and is indicated for improvement of visual field or for cosmetic improvement. A lateral canthoplasty with widening of the palpebral fissure by tightening the lateral canthal tendon will help in mild cases. In more extensive cases where the horizontal fissure is very narrow, a lateral canthotomy is performed with reconstruction of the eyelid margins by folding over the conjunctiva to cover the marginal tarsus. In ankyloblepharon filiforme simple lysis of the epithelial bands is sufficient.

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