IMAGING IMAJ • VOL 16 • December 2014

Ankyloblepharon Filiforme Adnatum Avi Rubinov MD1, Nir Seider MD1,2, Eedy Mezer MD1,2, Liron Berkovitz MD1, Eytan Z. Blumenthal MD1 and Imad R. Makhoul MD PhD2,3

Departments of 1Ophthalmology and 2Pediatrics and Neonatology, Rambam Health Care Campus, Haifa, Israel 3Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

grey line, located between the meibomian The images show the right and the left eye Key words: ankyloblepharon filiforme adnatum gland orifice line and the line. just before the surgery [Figures 1A and 2A] (AFA), pediatric , During normal prenatal development the and immediately after [Figures 1B and 2B]. neonatology remain fused until the fifth month of The following day an ocular examination IMAJ 2014; 16: 000–000 gestation; in some cases they may not sepa- including a dilated fundus examination did rate completely until as late as the seventh not reveal any additional abnormalities. month in utero. The prompt recognition and treatment AFA may be associated with iridogo- of AFA in the newborn is critical to prevent ilateral multiple fibrous tissue bands niodysgenesis, often complicated by juve- deep and to rule out possible B bridging the lids were identified upon nile [2]. Systemic associations rare systemic abnormalities. the birth of a Caucasian male born at 40 include trisomy 18 (Edward’s syndrome) weeks of gestation following a sponta- [3], Hay-Wells syndrome [4], the popliteal Correspondence Dr. A. Rubinov neous vaginal delivery and uneventful pterygyium syndrome (with intracrural 29/19 Keren Hayesod Street, Haifa 3497029, Israel pregnancy. Physical examination includ- webbing of the lower limbs), and CHAND email: [email protected] ing inspection of the anterior segment of syndrome (acronym for curly hair, anky- References the eyes through the fibrous bands did not loblepharon, nail dysplasia). Other rare 1. Judge H, Mott W, Gabriels J. Ankyloblepharon reveal any abnormal findings. This rare associations include hydrocephalus, filiforme adnatum. Arch Ophthalmol 1929; 2: 702-8. congenital anomaly is known as ankylo- meningiocele, imperforate anus, bilateral 2. Scott MH, Richard JM, Farris BK. Ankyloble- blepharon filiforme adnatum (AFA) and syndactyly, and structural cardiac defects pharon filiforme adnatum associated with infan- tile glaucoma and iridogoniodysgenesis. J Pediatr can exist as an isolated finding or as part such as patent ductus arteriosus and ven- Ophthalmol 1994; 31 (2): 93-5. of well-defined syndromes. tricular septal defect [5]. 3. Bacal DA, Nelson LB, Zackai EH, Lavrich JB, AFA describes a single or multiple bands Surgery to free these adhesions should Kousseff BG, McDonald-McGinn D. Ankyloble- pharon filiforme adnatum in trisomy 18. J Pediatr of fibrous tissue joining the upper and lower be performed as soon as possible to pre- Ophthalmol Strabismus 1993; 30 (5): 337-9. eyelids either unilaterally or bilaterally. vent the risk of occlusional amblyopia 4. Long JC, Blandford SE. Ankyloblepharon filiforme These connecting strands were found to (amblyopia secondary to reduced visual adnatum with cleft lip and palate. Am J Ophthalmol consist of a vascularized central core sur- stimuli). The fibrous bands were severed 1962; 53: 126-9. 5. Gruener AM, Mehat MS. A newborn with ankyloble- rounded by stratified squamous epithelium using a squint hook and scissors and then pharon filiforme adnatum: a case report. Cases J [1]. The bands consistently arise from the trimmed at their insertion to the grey line. 2009; 2: 8146.

Figure 1. [A] Right eye AFA Figure 2. [A] Left eye AFA [B] The same eye following the surgical procedure [B] The same eye following the surgical procedure A B A B

2