Ankyloblepharone is a pathology of the organ of vision, in which there is a complete or partial fusion of the edges of the eyelids. It is manifested by the presence of adhesions in the form of scars or cords between the upper and lower eyelid, narrowing or absence of an eye slit. Ankyloblepharone is diagnosed by visual examination and biomicroscopy; ophthalmoscopy, CT or MRI of the orbits, ultrasound of the eyeball are additionally performed. Treatment depends on the form of the disease: correction of congenital ankyloblepharone is only surgical; the acquired ankyloblepharone requires a comprehensive approach (drug therapy plus surgery), the choice of tactics depends on the primary disease.
Q10.3 Other malformations of the eyelid
Ankyloblepharon (from Greek ankylos – curved, crooked, blepharon – eyelid) is an eye disease in which partial or complete fusion of the upper and lower eyelids occurs, resulting in a reduced or completely absent eye slit. In clinical ophthalmology, congenital ankyloblepharone and acquired are distinguished. Congenital ankyloblepharone is a fairly rare pathology, its population frequency has not been determined. The acquired variant is more common, for example, after prolonged chronic inflammation of the eyelids or thermal eye burn. Acquired ankyloblepharone can occur at any age. It is diagnosed with the same frequency in men and women. It is found in all developed countries.
Causes of ankyloblepharone
Congenital ankyloblepharone, like other anomalies of the visual organ, can be inherited, both recessive and dominant. This pathology occurs in the structure of some hereditary syndromes: Hay-Wells syndrome, popliteal pterygium syndrome and a number of other ectodermal dysplasias. In some cases, ankyloblepharone may be caused by spontaneous mutations caused by the effect of teratogenic factors on the fetus.
Acquired ankyloblepharone occurs as a result of thermal burns of the eyes with acid, alkali, boiling water, molten metal. Also, the fusion of the eyelids can form after some diseases that lead to prolonged chronic inflammation of the edges of the eyelids, such as shingles, scar pimphegoid, Stevens-Johnson syndrome, diphtheria of the eyes. It is often combined with simblefaron (fusion of the conjunctiva of the eyelids with the conjunctiva of the sclera).
Symptoms of ankyloblepharone
The congenital form of pathology is detected immediately after birth. The fusion of the eyelids is more often observed on the temporal side, less often on the nasal side. At the same time, the lacrimal organs shift to the nose, the length of the lower lacrimal tubule also increases, the lacrimal muscle fuses with the inner part of the eyelid. It can occur in the form of a thin connective tissue strand, which is a residual element of complete fusion of the eyelids during embryonic development. An unchanged eyeball can be seen through it. Usually, congenital ankyloblepharone is combined with other anomalies of the development of the eyes or skull, such as cleft lip and hard palate, microphthalmos (abnormally small size of the eyeball), ptosis of varying degrees (drooping of the upper eyelid), epicanthus (a special fold at the inner corner of the eye), coloboma of the choroid (a developmental defect manifested by the absence of part of the choroid eyes), etc.
Clinical manifestations of acquired ankyloblepharone depend on the severity of the causal disease (blepharitis, burn). There is a lesion of the skin of the eyelids and underlying tissues, which further leads to scarring of the edges and the formation of ankyloblepharone. The disease can be accompanied by severe pain syndrome in the eye area, lacrimation, corneal opacity to the formation of scarring, sharp swelling of the conjunctiva up to necrosis.
Diagnosis of congenital ankyloblepharone is carried out during the examination of a newborn in the hospital by an ophthalmologist. With complete fusion of the eyelids, CT orbits and soft tissue echography are performed to identify other developmental abnormalities. Acquired ankyloblepharone is diagnosed using the method of biomicroscopy using a slit lamp. If possible, visual acuity is determined, intraocular pressure is measured, and the fundus is examined. With total fusion of the eyelids, an ultrasound of the eyeball or an MRI of the orbits is necessary to assess the state of the internal structures of the eyeball.
Treatment of this pathology is only surgical. With the congenital variant, the operation is prescribed as soon as possible after birth and consists in dissecting the adhesions between the eyelids. In the absence of additional developmental anomalies, the prognosis is favorable. Treatment of acquired ankyloblepharone consists in determining the cause of fusion. This is followed by a mandatory stage – drug therapy to stop inflammatory changes in the eyelid area. Surgical treatment is reduced to restoring the integrity of the eyelids, the operation is reconstructive.
Prognosis and prevention
The prognosis for vision is often unfavorable. Preventive measures are aimed at preventing the occurrence of only acquired ankyloblepharone. Prevention is based on compliance with all safety rules when working with dangerous chemicals, the use of personal protective equipment, such as glasses, gloves, masks. It is also necessary to protect the eyes and the skin of the eyelids from the effects of hot air and steam.