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ARTICLE
Year : 1969  |  Volume : 17  |  Issue : 4  |  Page : 160-162

Acquired band of adhesion between tarsal conjunctivae


Department of Ophthalmology, King George's Medical College, Lucknow, India

Date of Web Publication10-Jan-2008

Correspondence Address:
R C Saxena
Department of Ophthalmology, King George's Medical College, Lucknow
India
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Source of Support: None, Conflict of Interest: None


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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

How to cite this URL:
Saxena R C, Garg K C, Ramchand S. Acquired band of adhesion between tarsal conjunctivae. Indian J Ophthalmol [serial online] 1969 [cited 2021 Sep 25];17:160-2. Available from: https://www.ijo.in/text.asp?1969/17/4/160/38537

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 Top


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 Top


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 Top


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.


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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