Fornix Reconstruction in Cicatricial Ocular Surface Disease: A Narrative Review of Graft Materials, Surgical Techniques, and Medical Management.
- 1Research, Alabama College of Osteopathic Medicine, Dothan, USA.
- 2Ophthalmology, Emory University School of Medicine, Atlanta, USA.
- 3Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, USA.
Abstract
Conjunctival fornix reconstruction is performed to restore fornix depth following symblepharon formation or conjunctival contracture, thereby improving ocular surface function, the tear reservoir, and ocular motility. In severe cicatricial disease, it also serves as the foundational first step in staged ocular surface rehabilitation. However, long-term surgical success is often limited by recurrent fibrosis from chronic inflammation. This narrative review examines the graft materials, surgical techniques, and medical management used in fornix reconstruction. A structured search of PubMed/MEDLINE from database inception through July 2026 was conducted. Relevant literature included original research, case series, prior reviews, and clinical practice guidelines. Twenty-one publications met the eligibility criteria, 15 of which reported fornix-specific outcomes. Clinical findings consistently varied with disease severity. Amniotic membrane transplantation (AMT) alone produced favorable results in mild disease but substantially lower rates of complete success in advanced cicatrization. The addition of oral mucosal or conjunctival grafts improved outcomes in severe cases. Multimodal approaches combining cicatrix lysis, mitomycin C, mucosal grafting, and AMT achieved high rates of successful reconstruction in advanced disease. AMT combined with intraoperative mitomycin C also showed benefit in eyes with previously failed reconstruction. In contrast, outcomes were less durable in late-stage ocular cicatricial pemphigoid, with recurrent symblepharon on follow-up. Cultivated oral mucosal epithelial transplantation demonstrated encouraging intermediate- and long-term success, while cultivated limbal epithelial sheets appeared less effective in patients with more advanced disease. Because published definitions of success differ, reported rates are not directly comparable. Emerging approaches, such as tissue-engineered epithelial substitutes and contact lens-based stem cell delivery, may address limitations of current techniques but have not been established for fornix reconstruction. Overall, the evidence base consists predominantly of small, single-center, non-comparative case series. Future prospective multicenter studies using standardized severity grading, clearly defined success criteria, and longer follow-up are needed to better compare the effectiveness and durability of current reconstruction approaches.
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BibTeX
@article{awan2026fornix,
title = {{Fornix Reconstruction in Cicatricial Ocular Surface Disease: A Narrative Review of Graft Materials, Surgical Techniques, and Medical Management.}},
author = {Muhammad Awan and Cuneyt Ozkardes and Zhenyang Zhao and Mohammad Soleimani},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116613},
url = {https://europepmc.org/article/MED/42909214},
note = {CC BY},
}
RIS
TY - JOUR
TI - Fornix Reconstruction in Cicatricial Ocular Surface Disease: A Narrative Review of Graft Materials, Surgical Techniques, and Medical Management.
AU - Muhammad Awan
AU - Cuneyt Ozkardes
AU - Zhenyang Zhao
AU - Mohammad Soleimani
PY - 2026
DA - 2026/09/20
JO - Cureus
DO - 10.7759/cureus.116613
UR - https://europepmc.org/article/MED/42909214
AB - Conjunctival fornix reconstruction is performed to restore fornix depth following symblepharon formation or conjunctival contracture, thereby improving ocular surface function, the tear reservoir, and ocular motility. In severe cicatricial disease, it also serves as the foundational first step in staged ocular surface rehabilitation. However, long-term surgical success is often limited by recurrent fibrosis from chronic inflammation. This narrative review examines the graft materials, surgical techniques, and medical management used in fornix reconstruction. A structured search of PubMed/MEDLINE from database inception through July 2026 was conducted. Relevant literature included original research, case series, prior reviews, and clinical practice guidelines. Twenty-one publications met the eligibility criteria, 15 of which reported fornix-specific outcomes. Clinical findings consistently varied with disease severity. Amniotic membrane transplantation (AMT) alone produced favorable results in mild disease but substantially lower rates of complete success in advanced cicatrization. The addition of oral mucosal or conjunctival grafts improved outcomes in severe cases. Multimodal approaches combining cicatrix lysis, mitomycin C, mucosal grafting, and AMT achieved high rates of successful reconstruction in advanced disease. AMT combined with intraoperative mitomycin C also showed benefit in eyes with previously failed reconstruction. In contrast, outcomes were less durable in late-stage ocular cicatricial pemphigoid, with recurrent symblepharon on follow-up. Cultivated oral mucosal epithelial transplantation demonstrated encouraging intermediate- and long-term success, while cultivated limbal epithelial sheets appeared less effective in patients with more advanced disease. Because published definitions of success differ, reported rates are not directly comparable. Emerging approaches, such as tissue-engineered epithelial substitutes and contact lens-based stem cell delivery, may address limitations of current techniques but have not been established for fornix reconstruction. Overall, the evidence base consists predominantly of small, single-center, non-comparative case series. Future prospective multicenter studies using standardized severity grading, clearly defined success criteria, and longer follow-up are needed to better compare the effectiveness and durability of current reconstruction approaches.
SN - 2168-8184
ER -