Surgical treatment of total bilateral ankyloblepharon in a child: unusual case report

To report on the efficacy of surgical management of total bilateral ankyloblepharon in a child.

An 8-year-old African girl from Burundi presented with complete lid-corneo-conjunctival adhesion in both eyes, dating back 6 years. Preoperative ultrasound evaluation of anterior and posterior segment was detected. Electrophysiologic examinations showed low responses. Surgery was performed with scarring tissue removal through manual cleavage in order to separate tarsal conjunctiva and corneal stroma, followed by multiple human amniotic membrane grafts on the cornea, the entire bulbar surface, and fornices.

Ankyloblepharon removal, excellent width of fornices, and lid motility recovery were obtained. Nevertheless, corneal stroma remained cloudy. The patient's visual acuity reached hand movements perception at 6 months follow-up.

Even in the presence of deep deprivation amblyopia, total ankyloblepharon surgical removal and anatomic restoration of ocular surface is mandatory in children. Subsequent surgery including corneal keratoplasty or keratoprosthesis implant should be taken into consideration after an accurate evaluation of the cost/benefit ratio. Furthermore, these young patients could be enrolled in specific visual rehabilitation programs to enhance residual visual abilities.