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 might possibly 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
    • Substantial 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 originally 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