|Year : 1969 | Volume
| Issue : 4 | Page : 160-162
Acquired band of adhesion between tarsal conjunctivae
RC Saxena, KC Garg, S Ramchand
Department of Ophthalmology, King George's Medical College, Lucknow, India
|Date of Web Publication||10-Jan-2008|
R C Saxena
Department of Ophthalmology, King George's Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saxena R C, Garg K C, Ramchand S. Acquired band of adhesion between tarsal conjunctivae. Indian J Ophthalmol 1969;17:160-2
In this paper a most unusual case is demonstrated in whom an acquired band of adhesion was running from the tarsal conjunctiva of upper lid to tarsal conjunctiva of lower lid in their temporal third. The authors could not find similar condition in available ophthalmic literature here.
| Case report|| |
Patient M, a boy aged four years and three months came to the Ophthalmic section of Gandhi Memorial and Associated Hospitals, Lucknow on 5th November, 1967 with narrow palpebral fissure and development of a fleshy band on temporal side of the left eye underneath the lids since 6 months. Six months back the patient had developed acute conjunctivitis in both eyes with partial eversion of upper lids and profuse discharge, more so in the left eye. The eyes remained closed for nearly eight days. The patient was given some indigenous medicines for local use. He recovered after the above period but his mother noticed marked narrowing of the fissure and appearance of fleshy band on the outer part of the left eye underneath the lids. After a period of six months the fissure began to open more and the mother could notice movements of the eyeball freely underneath the fleshy band.
On examination, the palpebral fissure of the left side was narrow. The band was limited to the temporal one third of palpebral fissure and the eyeball could be seen freely moving underneath the band. Detailed examination of the band was done under general anesthesia. The band had two attached convex borders and two free concave borders. It had two free anterior and posterior surfaces. The upper convex border measuring 7 mm in size was attached to the upper palpebral conjunctiva at the level of the upper border of the upper tarsal plate. Similarly, the lower convex border measuring 6 mm in size was attached to the lower palpebral conjunctiva along the lower border of the lower tarsal plate. The free nasal concave border under slight stretch measured 12 mm. and the free temporal concave border measured 5mm. The band was 1.0 mm thick [Figure - 1]. An iris repositor passed under the band demonstrated its free under surface. The other eye showed no abnormality.
Conjunctival smear and culture were sterile. Excision of the band was done under general anesthesia. 1 mm of band was left attached to both the lids stitching the anterior and posterior margins with interrupted silk sutures. Slight bleeding from both the stumps showed presence of a few blood vessels in the band.
The excised band under microscope showed conjunctival epithelium and subepithelial tissue densely infiltrated by chronic inflammatory cells including lymphocytes, mononuclear and plasma cells. [Figure - 2],[Figure - 3].
| Discussion|| |
Histopathological examination of this band is in favour of a post-inflammatory band of adhesion. Since the case could not be examined during the period of acute inflammation and moreover his conjunctival smear on admission was sterile no assessment regarding causative organim could be made.
For development of such an adhesion a conjunctival raw area at the site of adhesion in both the lids approximating each other during the healing phase is essential. Such a raw area could develop due to virulence of organism, exposure and lack of nutrition or application of indigenous irritant drug of which there is a history. Approximation of the abraded conjunctival surfaces was only possible after partial eversion of both lids of which there is also a history. In this case authors believe that acute conjunctivitis was responsible for partial eversion which led to pressure and lack of nutrition at the site of eversion resulting in aberasions favoured by an irritant drug, probably antimony powder which is often used as an indigenous remedy in the villages. Partial eversion also brought about approximation of the abraded surfaces which developed a band of adhesion during the healing phase. The fact that eversion occurs along the upper margin of upper tarsus and lower margin of lower tarsus also explains the site of attachment of the band. During the phase of recovery, the band of adhesion formed was small but with subsidence of chemosis, reversions of lids to their normal position, and due to movements of lids, the band got stretched and elongated as the size of the palpebral aperture improved.
Unilateral involvement could be explained by unequal involvement of the two eyes. Involvement of temporal side was perhaps due to anatomical variation between the two canthi and collection of profuse discharges at the medial canthus keeping the lids apart and preventing adhesion formation.
The excision of bands as described gave complete recovery.
The authors also suggest a modified term to this condition. Since the band was running from upper lid to lower lid reducing the size of palpebral aperture and restricting the movements of the lids, this condition may be termed "Ankyloblepharon". As the site of adhesion was in tarsal conjunctivae of both the lids, this condition may be termed as "Ankyloblepharon conjunctive tarsalis".
| Summary|| |
An unusual case of post-inflammatory band of adhesion running from the upper tarsal conjunctiva to the lower tarsal conjunctiva reducing the palpebral fissure and interfering with movements of the lids has been described, with its possible pathogenesis and management. It may be called ankyloblepharon of the tarsal conjunctiva.
[Figure - 1], [Figure - 2], [Figure - 3]