Symblepharon
👁️ Symblepharon
🔍 Definition
Symblepharon is the adhesion (scar-like attachment) between the palpebral conjunctiva (lining of the eyelid) and the bulbar conjunctiva (covering the eyeball), leading to a restriction of eye movement and eyelid mobility.
📌 It does not involve the cornea directly but may limit vision by distorting eyelid and conjunctival anatomy.
🧬 Etiology (Causes)
| Category | Common Examples |
|---|---|
| Cicatrizing conjunctivitis | Stevens-Johnson syndrome, ocular cicatricial pemphigoid |
| Chemical burns | Especially alkali burns, which penetrate tissues deeply |
| Trauma | Direct injury to conjunctiva or burns |
| Post-surgical | After conjunctival surgeries without proper precautions |
| Infections | Severe trachoma (late stage) |
| Radiation exposure | Rare but can cause conjunctival fibrosis |
👀 Clinical Features
| Symptom / Sign | Description |
|---|---|
| Reduced eye motility | Adhesions restrict free movement of the eyeball |
| Foreign body sensation | Due to conjunctival scarring and distortion |
| Redness, irritation | From dry spots and poor tear film distribution |
| Cosmetic deformity | Visible web-like adhesions in severe cases |
| Keratopathy | From reduced blinking and lubrication |
| Shallow or obliterated fornix | Loss of normal conjunctival space |
🔍 Types of Symblepharon
| Type | Adhesion Between |
|---|---|
| Anterior | Lid margin to bulbar conjunctiva |
| Posterior | Palpebral conjunctiva to bulbar conjunctiva deeper in fornix |
| Total | Extensive adhesion involving large area |
| Partial | Localized band(s) of adhesion |
🧪 Diagnosis
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Clinical examination – evert eyelid to inspect conjunctiva and fornices
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Slit-lamp – assess adhesions, conjunctival scarring
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Schirmer’s test / tear film assessment – if dryness is present
💊 Treatment
🔹 Prevention (important after burns or surgery)
| Method | Purpose |
|---|---|
| Frequent ocular lubrication | Prevent drying and adhesion formation |
| Use of glass rod or symblepharon ring | Maintains fornix depth |
| Early eyelid stretching / massage | To prevent scar contraction |
🔹 Surgical Management
| Procedure | Indication |
|---|---|
| Symblepharon lysis | Surgical cutting of adhesion |
| Amniotic membrane graft (AMG) | Covers defect post-lysis, reduces recurrence |
| Mucous membrane graft (e.g., buccal) | For extensive cases or total symblepharon |
| Limbal stem cell transplantation | If limbal deficiency is contributing |
| Symblepharon ring insertion | Keeps fornix formed post-surgery |
⚠️ Complications
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Recurrence (common without proper post-op care)
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Dry eye
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Reduced ocular motility
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Cosmetic deformity
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Difficulty wearing contact lenses
🧠 Mnemonic: "Sym-bond = Symblepharon"
➤ "Sym" = together, "blepharon" = eyelid → structures stick together abnormally.
📋 Quick Summary Table
| Feature | Symblepharon |
|---|---|
| Definition | Adhesion between eyelid & eyeball |
| Common cause | Chemical burns, cicatricial conjunctivitis |
| Symptoms | Restriction of eye movement, irritation |
| Diagnosis | Clinical exam (with lid eversion) |
| Treatment | Prevention, lysis + grafting if needed |
Would you like:
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A diagram showing types of symblepharon?
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A flashcard-style summary?
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Or real clinical cases for better understanding?
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