A symblepharon is a fibrous adhesion of the palpebral conjunctiva and the bulbar conjunctiva of the eye. It is most commonly caused by a response to inflammation, as a result of inherited or systemic disease, or trauma.
The symptoms of symblepharon are dependent on the degree of the fibrous adhesions . The adhesions that are located between the palpebral conjunctiva and the bulbar conjunctiva may occur only in the anterior region (anterior symblepharon), in the fornix (posterior symblepharon), or comprise the whole eyelid (total symblepharon). Patients may complain of mucous build up around the corners of the eye, eye redness, frequent tearing, feeling of 'dry eye' that is attributed to an inability to close the eyelid, restriction of ocular motility, reduced visual acuity, and/or involvement of the cornea. Additionally, diplopia (which occurs secondary to restricted ocular motility), entropion (eyelid inverted or folded inward), inability to fully close the eyelids (lagophthalmos), and altered cosmetic appearance may also be present .
Workup consists of a review of medical history, assessment of current medications, and an ocular examination . Laboratory tests may be performed when they are clinically indicated or to rule out a disease that is associated with symblepharon . Symblepharon is a physical finding that can be a result of one of many etiologies. Therefore, the patient's medical history should include questions that evaluate presence of conditions commonly associated with symblepharon like ocular cicatricial pemphigoid, history of trauma, ocular chemical exposure, or conjunctival burns, recent ocular surgeries, pseudopemphigoid conditions, Stevens-Johnson syndrome, sarcoidosis, atopic keratoconjunctivitis, porphyria cutanea tarda, epidemic keratoconjunctivitis, squamous papilloma of the conjunctiva, ocular rosacea, and xeroderma pigmentosum     .
The ocular examination should consist of the following:
Depending on the clinical findings, laboratory tests to rule out associated systemic diseases may be performed. These include complete blood count (CBC), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA) levels, rheumatoid factor (RF), rapid plasma reagin (RPR), and uric acid level. Patients who are suspected of having dry eye syndrome should be tested for fodrin (a cytoskeletal protein), muscarinic M3 receptor, and sjögren syndrome (SS) specific antibodies (anti-RO [SS-A] and anti-LA [SS-B]) to confirm the diagnosis. Patients who have signs and symptoms of Stevens-Johnson syndrome will have increased levels of tumor necrosis factor (TNF)–alpha by the local tissue dendrocytes and T-cell proliferation  . The following antibodies can be tested to rule out cicatricial pemphigoid: bullous pemphigoid antigen 1 and 2 (BPAG, BPAG2), type VII collagen, laminin 5, laminin 6, and b4 integrin subunit .