What are the other Names for this Condition? (Also known as/Synonyms)

• Fused Eyelids

What is Ankyloblepharon? (Definition/Background Information)

• Ankyloblepharon, or Fused Eyelids, is a medical condition involving the eyelids. In Ankyloblepharon, both the lower and upper eyelids are either partially or completely fused to each other. But for this abnormality, the anatomical structure and functioning of the eyelids are normal
• In a majority of cases, Ankyloblepharon is a congenital condition (present at birth); in many, it forms part of certain genetic disorders. It may be also caused by eye injuries, eye infections, and Steven-Johnson syndrome (acquired Ankyloblepharon)
• A treatment of Ankyloblepharon involves treating any underlying causative condition. In a majority of cases, the prognosis of isolated cases of Ankyloblepharon is good with treatment. However, if it forms part of a systemic condition/syndrome, then the overall prognosis depends on the severity of the underlying condition

Who gets Ankyloblepharon? (Age and Sex Distribution)

• Congenital Ankyloblepharon may be diagnosed following the birth of the child
• Individuals in any age category (children and adults) may be affected by acquired Ankyloblepharon
• Both males and females may be affected
• Worldwide, individuals of all races and ethnicity are prone to developing the condition

What are the Risk Factors for Ankyloblepharon? (Predisposing Factors)

No specific risk factors are identified for congenital Ankyloblepharon. However, it may be seen with a host of syndromes such as:

• Curly Hair, Ankyloblepharon and Nail Dysplasia (CHAND) syndrome
• Ectrodactyly ectodermal dysplasia and cleft lip/cleft palate (EEC) syndrome
• Edwards syndrome (trisomy 18 syndrome)
• Hay-Wells syndrome
• Popliteal pterygium syndrome
• Rapp-Hodgkin syndrome

The risk factors for acquired Ankyloblepharon include:

• Bacterial conjunctivitis
• Burn injuries
• Chemicals splashing in the eye
• Eye trauma
• Herpes simplex infection
• Ocular cicatricial pemphigoid
• Stevens-Johnson syndrome
• Superglue injuries involving the eye
• Surgical procedures such as tarsorrhaphy
• Trachoma
• Ulcerative blepharitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ankyloblepharon? (Etiology)

Ankyloblepharon is an eye condition in which the upper and lower eyelids are fused along their margins, either fully or partially.

• Typically, a baby’s eyes remain closed until the fifth/sixth month of gestation. The eyelids separate around the seventh month, but sometimes may fail to separate along the eyelid margins fully or partially, due to some fetal development issue. This is termed as congenital Ankyloblepharon
• The congenital form may sometimes occur in isolation (sporadic), or it may form part of a (systemic) syndrome

In acquired Ankyloblepharon, the cause may be due to other eye injuries or trauma secondary to infections or medical disorders, such as ulcerative inflammation, skin conditions, and conjunctivitis.

What are the Signs and Symptoms of Ankyloblepharon?

Based on the severity of the condition, there are three forms of Ankyloblepharon:

• Complete Ankyloblepharon - where the eyelids are completely fused along their margins
• Partial Ankyloblepharon - the eyelids are fused at single or multiple points through connecting strands (usually about 0.5 mm in width and 1-10 mm in length)
• Interrupted Ankyloblepharon - the eyelids are attached at different points through multiple extensible tissue strands, along the lid margin. This form is also known as Ankyloblepharon filiforme adnatum

In the partial and interrupted forms, the extreme corners of the eyelids are usually spared; the strands are not present on the periphery. The strands are seen to originate from behind the eyelashes on the upper and lower eyelids.

Ankyloblepharon is different from blepharophimosis, which is a narrowing of the eye opening. The signs and symptoms of Ankyloblepharon are dependent on the type - whether it is complete, partial, or interrupted. However, apart from compromised vision, no other significant eye signs and symptoms are noted unless the condition forms part of a syndrome.

• Complete Ankyloblepharon indicates that the eye is closed, and there is no vision in the affected eye
• Partial and interrupted forms allow only partial vision
• Decreased eyelid movement (in the involved eye)
• Pseudoexotropia - eye alignment appears to be turned outward, even though they are straight
• Cystic formation from tear accumulation, which is noted in total Ankyloblepharon
• A single eye or both the eyes may be involved

Additional signs and symptoms of the underlying/associated condition, if any, may be noted.

How is Ankyloblepharon Diagnosed?

Typically, Ankyloblepharon may serve as an indication for the presence of other systemic conditions, which may need further investigation. The following observations and tests may be undertaken by the healthcare provider:

• Physical examination and medical history evaluation, including evaluation of family history
• Assessment of the presenting signs and symptoms
• General eye exam: A simple eye exam can help the ophthalmologist detect the condition. However, further testing may be necessary to diagnose the underlying cause (if any present)
• Imaging studies, including CT and MRI scans of the body, may be undertaken based on the healthcare provider’s evaluation, in order to rule out other conditions
• Other tests and procedures to diagnose the associated condition, if any present, is important

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ankyloblepharon?

The lack of early treatment of Ankyloblepharon may result in complications due to atrophy from lack of usage of the eye. The complications may include:

• Severely restricted field of vision
• Amblyopia or lazy eye
• Cosmetic concerns
• Decreased quality of life

Individuals with other underlying/associated conditions may present additional complications.

How is Ankyloblepharon Treated?

• The treatment of choice for Ankyloblepharon is surgery, which can help resolve the condition
• However, treating the symptoms and managing any associated condition/disorder (if present) is also important
• Rarely, in some children, the connecting bands of the eyelid are known to release spontaneously

How can Ankyloblepharon be Prevented?

Currently, it is not possible to prevent Ankyloblepharon in many cases. However, the following factors may be considered to lower one’s risk for the same:

• For congenital Ankyloblepharon:
  • Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
  • If there is a family history of a systemic/syndromic condition, then genetic counseling will help assess risks, before planning for a child
• For acquired Ankyloblepharon:
  • Undertake early and adequate treatment of any eye conditions/infections
  • Wear proper protective gear like goggles, whenever you are handling chemicals/glues
  • Understand and strictly adhere to manufacturer instructions, while handling/pouring/using chemicals
  • Follow safety protocols associated with machines including cooking equipment that have fire hazard
  • Use protective gear when working with hot objects
  • Use fire alarms and smoke detectors to limit exposure, in case of a fire
  • Wear helmets and safety gear while participating in sports or while driving, to prevent head/eye injury

What is the Prognosis of Ankyloblepharon? (Outcomes/Resolutions)

The overall prognosis of Ankyloblepharon depends on the severity of the underlying condition and the treatment response.

• Sporadic Ankyloblepharon generally has a good prognosis following proper (simple) surgical management of the condition
• If left untreated, Ankyloblepharon may lead to various eye complications permanently affecting vision, including causing total blindness, even though the eye structure may be healthy

Additional and Relevant Useful Information for Ankyloblepharon:

Please visit our Eye & Vision Health Center for more physician-approved health information:

https://www.dovemed.com/health-topics/vision-center/