Bilateral Ankyloblepharon Filiforme Adnatum: A Case Report Highlighting the Importance of Early Recognition and Treatment

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly characterized by bands of tissue connecting the upper and lower eyelids, which can lead to visual deprivation and subsequent amblyopia if left untreated. We report a case of a one-month-old girl who presented with bilateral eyelid adhesions causing restricted eyelid opening. The patient was born at 39 weeks of gestation with no prenatal complications. Physical examination revealed tissue bands connecting the eyelids bilaterally, with more severe restriction on the left side. Comprehensive systemic evaluation ruled out associated syndromic conditions, confirming isolated AFA. Due to the risk of deprivation amblyopia during the critical period of visual development, surgical separation of the eyelid adhesions was performed under general anesthesia at three months of age using electrocautery. Histopathological examination confirmed keratinized stratified squamous epithelium. Postoperatively, significant hyperopia and anisometropia were noted, which showed a myopic shift at two-month follow-up. Both eyelids remained well separated with good fixation and tracking in both eyes. This case emphasizes the critical importance of early recognition and prompt surgical intervention in AFA to prevent visual developmental complications. Timely management is essential to avoid stimulus deprivation amblyopia and ensure optimal visual outcomes, particularly in bilateral or extensive cases where the risk of visual impairment is heightened.