ANKYLOBLEPHARON

It is defined as adhesion of the edges of upper eyelid with the lower eyelid. The eyelids maintain their integrity and identity. The condition is usually congenital but may be acquired. In congenital ankyloblepharon, the fused eyelids fail to separate completely during development of embryo. Congenital ankyloblepharon is caused by developmental arrest leading to aberration in growth at either medial or lateral canthus. It may occur as a sporadic finding or in association with chromosomal/syndromic conditions.

Ankyloblepharon may be complete, partial, or interrupted.

In interrupted form, known as ankyloblepharon filiforme adnatum (AFA), epithelial bands are present between the lower and upper eyelids. These fine extensile cords attaching lower and upper eyelids may be single or multiple. The cords decrease the palpebral fissure height and reduce excursion of eyelids.

CAUSES:

Congenital

• Hay-Wells syndrome: A rare autosomal dominant disorder, known as Hay-Wells syndrome, may be associated with ankyloblepharon, ectodermal defects, and cleft lip and palate (AEC syndrome).

• Curly hair, ankyloblepharon and nail dysplasia (CHAND) syndrome: This is an autosomal recessive disorder which is characterised by ankyloblepharon and ectodermal dysplasia, but affected patients have curly hair and hypoplastic nails, with absence of cleft lip or palate.
• Edwards’ syndrome or Trisomy 18: Edwards’ syndrome or Trisomy 18 patients may also have ankyloblepharon filiforme adnatum.
• Rapp-Hodgkin syndrome: This is an autosomal dominant syndrome characterised by ectodermal dysplasia, cleft lip and/or palate, and mid-facial hypoplasia.

Acquired

• Chemical injuries to the eyes.
• Burns.
• Stevens-Johnson syndrome.
• Post traumatic prolonged contact of upper and lower eyelid.
• Trachoma.
• Ulcerative blepharitis.
• Herpes simplex blepharoconjunctivitis.
• Diphtheritic conjunctivitis. 

SYMPTOMS

• Complete, partial, or interrupted fusion of upper and lower eyelids.
• Horizontal foreshortening of the palpebral fissure.
• Pseudoexotropia due to lateral ankyloblepharon.
• Pseudoesotropia due to medial ankyloblepharon.
• Reduced eyelid excursion.
• Associated features such as anophthalmos (absence of eyeball), microphthalmos (small eyeball), ptosis (drooping of eyelid), or cleft lip.
• Downward displacement of lateral canthal angle.
• Large fluid cyst due to accumulation of lacrimal tears in cases of total ankyloblepharon.

DIAGNOSIS:

Detailed ocular examination is performed including measurement of intraocular pressure. Any ocular features of hydrocephalus are noted. 

Screening may be required to rule out any genetic disorder associated with ankyloblepharon.

Differential diagnosis

Ankyloblepharon may be differentiated from

• Blepharophimosis: In blepharophimosis, the palpebral aperture is reduced and there is telecanthus (increased medial intercanthus distance), but the eyelid margins are normal.
• Euryblepharon: In both euryblepharon and ankyloblepharon, the lateral portion of the eyelid may be lax and displaced downward. In ankyloblepharon, the eyelid margins are fused together for some distance producing a shorter horizontal palpebral fissure.  The fissure is longer than normal in cases of euryblepharon.
• Cryptophthalmos (congenital absence of eyelid with skin passing continuously from head to cheeks over mal-formed eye).
• Microphthalmos (small eyeball).
• Pseudostrabismus

HOMOEOPATHIC MANAGEMENT:

LYCOPODIUM- Sees only one-half of an object. Ulceration and redness of lids. Eyes half open during sleep.

NUX MOS- Objects look larger, very distant, or vanish. Motes before eyes. Mydriasis.

MEZ - Ciliary neuralgia after operations.

OL-AN - Smarting in eyes; misty vision. Glistening bodies before eyes. Lachrymation when eating. Short-sighted. Twitching of lids (Agar).

CONIUM - Photophobia and excessive lachrymation. Corneal pustules. Dim-sighted; worse, artificial light. On closing eyes, he sweats. Paralysis of ocular muscles.