What is Symblepharon?

A symblepharon is a fibrous tract that connects bulbar conjunctiva toconjunctiva on the eyelid.

Symblepharon, Normal Fornix	Symblepharon, Upper Fornix

When do symblepharon occur?

• Cicatricial pemphigoid; auto-immune disease which affects mucus membranes such as the mouth and oral pharynx, conjunctiva, nares and genitalia
• Atopic keratoconjunctivitis: This is a hypersensitivity to environmental allergies including asthma, rhinitis, dermatitis and eczema.
• Trichiasis: A lid abnormality in which eyelashes are misdirected towards the eyeball. These misdirected lashes may often be the result of scarring.
• Toxic epidermal necrosis (TEN): A potentially life-threatening disorder which is commonly drug-induced.

• Stevens Johnson Syndrome
  • Characteristics:
    • Equal age and sex distribution
    • Severe disease associated with a 5-15% mortality rate
    • Ocular involvement in 50%
    • Associated with various infections and medications most notably sulfa
    Ocular involvement in 50%
  • Pathogenesis:
    • Angiitis-->Erythematous lesion-->Bullae-->Rupture-->Scar
  • Prodrome:
    • Fever, chills, and headache
    • 7 days later bullous mucosal lesions develop
  • Sequelae:
    • Problems are related to the destruction of Goblet cells and a lack of conjunctival mucus which leads to keratinization and scarring.
    • Lid scarring with symblepharon
    • Corneal scarring
    • Keratitis sicc
• Burns
• Erythema multiforme: This is an acute multi-cutaneous hypersensitivity reaction

What are the treatment options?

• Why use Amniotic membrane? Because it:
  • facilitates epithelialization
  • maintains normal epithelial phenotype (with goblet cells when performed on conjunctiva ),
  • reduce inflammation, vascularization and scarring.

The use of human amniotic membrane for the surgical treatment of an ocular surface disorder was first reported by de Rotth ¹⁶ in 1940. During the 1990s, the role of amniotic membrane transplantation in treating a variety of ocular surface defects and abnormalities has been revived.

Chemical Burns	Pterygium
Corneal/Sclera Ulceration & Peforations	Tumors
Stevens-Johnson's Syndrome

Graves' disease is an autoimmune disease. It most commonly affects the thyroid, causing it to grow to twice its size or more (goiter), be overactive, with related hyperthyroid symptoms such as increased heartbeat, muscle weakness, disturbed sleep, and irritability. It can also affect the eyes, causing bulging eyes (exophthalmos). It affects other systems of the body, including the skin and reproductive organs. It affects up to 2% of the female population, often appears after childbirth, and has a female:male incidence of 5:1 to 10:1. It has a strong hereditary component; when one identical twin has Graves' disease, the other twin will have it 25% of the time. Smoking and exposure to second-hand smoke is associated with the eye manifestations but not the thyroid manifestations. Diagnosis is usually made on the basis of symptoms, although thyroid hormone tests may be useful, particularly to monitor treatment.

Trichiasis is a medical term for abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva. This can be caused by infection, inflammation, autoimmune conditions, and trauma such as burns or eyelid injury.