Ankyloblepheron of tarsal conjunctiva

Abstract

A 6-month-old infant with Down syndrome presented at Guru Nanak Eye Centre, New Delhi with bilateral palpebral fissure narrowing and adhesions between the upper and lower tarsal conjunctiva following membranous conjunctivitis 3 months prior (A). Anatomic details of the cornea and fornices could not be appreciated, but the eye moved freely underneath the fleshy band, which was limited to the central and lateral parts of the eye. An iris repositor passed underneath the band showed its free undersurface. The band was surgically divided and excised, and amniotic membrane was used to cover the raw conjunctival surfaces (B-C). Postoperatively, congenital total cataract was noted in both eyes, for which the child underwent surgery. The palpebral fissure height and lid position reverted to normal (D). The term ankyloblepharon is traditionally reserved for adhesions between the lid margins, which may be congenital or can develop secondary to conditions such as chemical burns and Stevens-Johnson syndrome. In the present case, the attachments were at the tarsal conjunctival surface, which was probably left raw at the time of initial infection, allowing approximation of the abraded surfaces subsequently. Beyond conservative management, surgery may be required in severe membranous conjunctivitis to manage alterations secondary to the fibrosing process. Amniotic membrane serves as a good substrate to restore the structural integrity and preserve useful vision.