Fornix Reconstruction

The conjunctival tissue starts from the limbus and ends in the lid margin. According to the anatomic location, the conjunctiva can be subdivided into the bulbar and palpebral portions; palpebral conjunctiva can further be subdivided into tarsal and forniceal portions. Under normal circumstances, the fornix is deep creating a tear reservoir for the formation of a tear meniscus. A normal, deep fornix also helps provide a full range of ocular motility when there is a natural, smooth contact between the lid and globe during the blink. Collectively, it helps maintain a stable tear film and a healthy ocular surface.

Obliteration or foreshortening of the fornix by a symblepharon due to scar tissue (cicatrix) may result in ocular surface failure. The pathogenic elements include: sicca due to the depletion of the tear flow and spread; blink-related microtrauma due to cicatricial entropion, lid margin/tarsal keratinization/scarring or misdirected lashes; exposure due to inadequate blinking and closure; entropion and ptosis; and restriction of ocular motility.

When symblepharon develops in the superotemporal fornix, severe sicca can develop by the blockage of the lacrimal gland. When symblepharon develops in the inferior fornix, nocturnal corneal exposure may further develop due to the loss of the Bell's phenomenon during sleep. Although there are diverse causes for developing symblephara, inflammation is invariably the common denominator. If uncontrolled, inflammation can progressively cause additional scarring worsening the symblepharon and fornix obliteration.

Depending on the location and severity of symblepharon, fornix obliteration can be pathogenic and even give rise to severe visual loss. In moderate to extreme situations, fornix obliteration may cause difficulties for contact/scleral lens insertion and wear; result in ankyloblepharon and socket contraction. All potential pathogenic elements of symblepharon are summarized below.

Pathogenic Elements of Symblepharon

1. Causing Dry Eye Obliteration of lacrimal excretory ductules
2. Contributing to Dry Eye Obliteration of tear meniscus, interference with lid blinking and closure
3. Causing Blink-related Microtrauma Cicatricial entropion together with abnormal lid margins, tarsi and lashes
4. Causing Diplopia Restriction of ocular motility
5. Causing Decreased Vision Cicatricial ptosis and symblepharon extending to the cornea
6. Partaking in Ocular Surface Failure Carrying uncontrolled inflammation
7. Interfering with Contact (Scleral) Lens Wear Ankyloblepharon or socket contraction

 

[Expand all]

  • Stages of Symblepharon
  • Symblepharon Management
  • Supplies for Fornix Reconstruction Surgery
  • Fornix Reconstruction Surgical Technique
  • Fornix Reconstruction Surgical Technique for Mild Symblepharon
  • Fornix Reconstruction for Moderate Symblepharon
  • Fornix Reconstruction for Severe Symblepharon
  • Post-Operative Points
  • Literature Summary
  • Frequently Asked Questions (FAQ)
  • References

Documents

Fornix Reconstruction surgical guide

 

Videos


  • Surgical Step Overview Video

  • Technique for Moderate Symblepharon Video

  • Technique for Moderate Symblepharon including covering the muscle Video

  • Fornix Reconstruction for Late Stage Chemical Burn Surgical 1 Video

  • Fornix Reconstruction for Late Stage Chemical Burn Surgical 2 Video

  • Late Stage Chemical Burn Treatment Video
     

  • Technique for Covering the Muscle Video

  • Technique for Wrapping Muscle Video

If you have additional surgical questions after viewing this information, contact OSREF's Research Director, Scheffer C.G. Tseng, MD, PhD, by e-mail at stseng@ocularsurface.com or by phone at 305-274-1299.

Videos edited by: Scheffer C.G. Tseng, MD, PhD, Hosam Sheha, MD, PhD, Ahmad Kheirkhah, MD, Antonio Elizondo, MD, Victoria Casas, MD

Note: The videos are for peer discussion purposes and the creators are not participating in commercial promotion of any product.

Financial Interest Disclosure: Dr. Tseng and his family are more than 5% shareholders in TissueTech, Inc. and Bio-Tissue, Inc. which currently distributes AMNIOGRAFT® and PROKERA™

Copyright © 2011 Ocular Surface Research & Education Foundation. Content is protected under intellectual property laws and are licensed for non-commercial viewing only. Any distribution, copying transmission or alteration is prohibited. All rights reserved.