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What is Symblepharon?

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

 

Cosmetic & Reconstructive Facial Eyelid & Orbital surgery @ Eye Plastics.
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 could 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 initially 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