Ocular Surface Reconstruction With Amniotic Membrane Transplantation For Lyme Keratitis Associated Symblepharon

To report the surgical management of severe symblepharon following Lyme keratitis using Amniotic Membrane (AM) transplantation.

Eskişehir Osmangazi University Department of Ophthalmology, Eskişehir, Turkiye

A 75 years old male patient presented to our clinic with complaints of pain, vision loss, and purulent discharge persisting for over two weeks in his left eye. He had no history of prior ocular surgery or systemic disease. Five days earlier, he was seen at another ophthalmology clinic, where he was commenced on moxifloxacin eye drops, nepafenac eye drops, and oxytetracycline pomade therapy. On assessment, his visual acuity was 1 meter counting fingers in the right eye and perception of light on the left eye. Corneal haze and vascularisation indicative of prior interstitial keratitis were observed in the right eye. A symblepharon was noted between the upper eyelid and central cornea, along with the keratitis lesion on the inferior cornea in the left eye. The patient was admitted for keratitis treatment and further investigations. Among the microbiological and blood tests, only Lyme IgM was positive. Corneal scraping cultures revealed no detectable microorganisms. He was started on topical administration of cefazolin and amikacin empirically and cyclopentolate eye drops, alongside oral tetracycline. Following the alleviation of the symptoms, patient was planned for surgery for removal of symblepharon with AM transplantation. Symblepharon was dissected and AM was placed and sutured over cornea and conjunctiva, reaching to superior fornix. Subsequently AM was spread to cover the palpebral conjunctiva and lid margin. Anchoring sutures were used to secure the AM to the eyelid skin.

Symblepharon can develop as a consequence of traumatic, infection-related or immune- mediated inflammatory conditions. In Lyme Disease, symblepharon can occur secondary to conjunctivitis, scleritis, episcleritis, or keratitis. Combining symblepharon removal and AM transplantation is an effective treatment modality for symblepharon linked with infection related inflammatory etiologies.