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Symblepharon

Conjunctival Adhesion

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.


Presentation

The symptoms of symblepharon are dependent on the degree of the fibrous adhesions [1]. 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 [2].

Overeating
  • Abstract Use of conjunctival material for grafting over areas of the eye denuded by removal of a pterygium, pseudopterygium or symblepharon gives better results cosmetically, and in some instances functionally, than either thin split skin or mucous membrane[ncbi.nlm.nih.gov]
  • Electroencephalography detected slow-wave activity over the right frontoparietal region.[ncbi.nlm.nih.gov]
  • METHODS: The records of 34 eyes of 25 patients with cryptophthalmos who sought treatment at the authors' tertiary eye care center over a period of 22 years were analyzed.[ncbi.nlm.nih.gov]
  • A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization.[ncbi.nlm.nih.gov]
  • Mild recurrences of adhesions have occurred in areas posterior to the KLAL graft and none have recurred over the KLAL segments.[ncbi.nlm.nih.gov]
Burning Eyes
  • Ozdemir O, Tekeli O, Ornek K et al (2004) Limbal autograft and allograft transplantations in patients with corneal burns. Eye 18:241–248 doi: 10.1038/sj.eye.6700640 PubMed CrossRef Google Scholar 17.[link.springer.com]
  • The thermally burned eyes had a more rapid recurrence than the chemically burned eyes ( P  0.035, Fig. 3 ). The more severe for the length of the symblepharon, the more rapid the recurrence developed ( P 4 ).[bmcophthalmol.biomedcentral.com]
Burning Sensation
  • For most patients, the common symptoms include: Redness Tearing Burning sensation Foreign body sensation Photophobia Lid heaviness Blepharospasm Finally, patients can also present with ocular motility disorders, diplopia, entropion, and inadequate lid[visualdx.com]

Workup

Workup consists of a review of medical history, assessment of current medications, and an ocular examination [3]. Laboratory tests may be performed when they are clinically indicated or to rule out a disease that is associated with symblepharon [4]. 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 [5] [6] [7] [8] [9].

The ocular examination should consist of the following:

  • Assessment of extraocular movements (EOMS): EOMS will show restricted ocular movements.
  • An external and slit-lamp examination: This is done by everting the eyelids and inspecting the palpebral conjunctiva for any scarring or symblepharon during an upward gaze.
  • A visual acuity test: In most patients with symblepharon, their visual acuity is usually normal, nearly normal, or unaffected by the condition itself.
  • Intraocular pressures (IOP): IOP should also be evaluated to rule out other conditions.

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 [10] [11]. 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 [12].

Treatment

  • It is rarely congenital. [ citation needed ] and its treatment is symblepharectomy. References [ edit ] Holsclaw, DS (1998).[en.wikipedia.org]
  • The success of surgical treatment was dependent on the effective control of inflammation and timely management of eyelid abnormalities.[ncbi.nlm.nih.gov]
  • AIM: Treatment of recurrent pterygium associated with symblepharon requires both suppression of fibrosis and reconstruction of limbal barrier. To achieve this, human amniotic membrane was transplanted and limbal autografts performed.[ncbi.nlm.nih.gov]
  • Our aim was to evaluate the efficacy of amniotic membrane transplantation in the surgical treatment of symblepharon by determining the rate of epithelization of the graft, the incidence of complications, and the rate of recurrence of cicatrization.[ncbi.nlm.nih.gov]
  • Cryptophthalmos: surgical treatment of the congenital symblepharon variant. Abstract A case of the congenital symblepharon variant of cryptophthalmos is reported. Surgical treatment is described.[bjo.bmj.com]

Prognosis

  • […] title features more than 150 color illustrations throughout and a short, succinct format which in most cases, includes: Epidemiology and Etiology, History, Physical Examination, Differential Diagnosis, Laboratory and Special Examinations, Diagnosis, Prognosis[books.google.es]
  • After the inflammation is controlled, surgical planning of the eyelid, anterior segment and cornea can be done based on the visual needs of the patient and prognosis after surgery.[eyeworld.org]
  • Patients whose symblephara was caused by thermal burns had a worse prognosis when the symblepharon severity was similar. The recurrence of symblephara also occurred earlier in eyes with thermal burns than chemical burns.[bmcophthalmol.biomedcentral.com]

Etiology

  • A very rare tumor presentation might be considered, but more significant is the determination of the underlying etiology.[visualdx.com]
  • Each title features more than 150 color illustrations throughout and a short, succinct format which in most cases, includes: Epidemiology and Etiology, History, Physical Examination, Differential Diagnosis, Laboratory and Special Examinations, Diagnosis[books.google.es]
  • RESULTS: Etiology of symblepharon included chemical burn (n 16), thermal burn (n 7), Stevens-Johnson syndrome (n 5), mucous membrane pemphigoid (n 2), xeroderma pigmentosum (n 1), and graft-versus-host disease (n 1).[ncbi.nlm.nih.gov]
  • PURPOSE: To report the surgical outcome of "sealing the gap" in treating symblepharon caused by various etiologies other than recurrent pterygium. DESIGN: Retrospective, interventional case series.[ncbi.nlm.nih.gov]
  • Symblepharon is a physical finding that can be a result of one of many etiologies.[symptoma.com]

Epidemiology

  • Each title features more than 150 color illustrations throughout and a short, succinct format which in most cases, includes: Epidemiology and Etiology, History, Physical Examination, Differential Diagnosis, Laboratory and Special Examinations, Diagnosis[books.google.es]
  • Epidemiology of epilepsy in developing countries. Bull World Health Organ. 1993; 71(2): 247–258. Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurology 2005; 4(1): 21-31. Anyanniyi AA.[informaticsjournals.com]
  • April 2009 Volume 50, Issue 13 Free ARVO Annual Meeting Abstract April 2009 Epidemiology of Symblepharon in a Mexican-mestizo Population Author Affiliations & Notes T. N.[iovs.arvojournals.org]
  • You are ( * ) If you have selected the “Other” category, please specify which type of user you are: * Email address: * Topic of your comment * Epidemiology data Summary and related texts Related genes Clinical signs Nomenclature and/or coding Your message[orpha.net]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology is still unknown, although there are several theories proposed, ranging from autoimmune to infectious. [Read more...] EyeWiki News 2019 Residents and Fellows Contest is now open .[eyewiki.aao.org]
  • Shimazaki (co-chair), (None) Anatomy, Physiology, and Pathophysiology Subcommittee: E. Knop (chair), (None) N. Knop, (None) T. Millar, Alcon (F), Allergan (F) H. Obata, (None) D.A.[tearfilm.org]

Prevention

  • We report a case with application of a Megasoft Bandage Lens to prevent symblepharon reformation after surgical correction. Complete epithelial healing was established after 3 months, when the lens could be removed.[ncbi.nlm.nih.gov]
  • CONCLUSION: Application of a gelatin sponge proved to be a simple and effective way of preventing symblepharon formation after an alkali burn.[ncbi.nlm.nih.gov]
  • Tranilast ophthalmic solution may be effective not only for prevention of pterygium recurrence, but also for inhibition of symblepharon and granuloma formation.[ncbi.nlm.nih.gov]
  • A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization.[ncbi.nlm.nih.gov]
  • After meticulous symblepharon lysis and scar tissue removal, KLAL tissue was sutured onto the ocular surface and used as a spacer to prevent recurrent scar formation. Patients have been followed from 12 to 28 months.[ncbi.nlm.nih.gov]

References

Article

  1. Holsclaw DS. Ocular cicatricial pemphigoid. Int Ophthalmol Clin. 1998;38:89-106.
  2. Romanes GJ. Treatment of established symblepharon with split skin homograft. Brit J Opthal. 1953; 37: 236-41.
  3. Gruchalla RS. 10. Drug allergy. J Allergy Clin Immunol. 2003 Feb. 111(2 Suppl):S548-59.
  4. King MJ. Ocular lesions in Boeck′s sarcoid. Trans Am Ophthalmol Soc. 1939;37:422–58.
  5. Moin M, Kersten RC, Bernardini F, Kulwin D. Destructive eyelid lesions in sarcoidosis. Ophthal Plast Reconstr Surg. 2001;17:123–5.
  6. Flach A. Symblepharon in sarcoidosis. Am J Ophthalmol. 1978;85:210–4.
  7. Assier-Bonnet H, Aractingi S, Cadranel J, Wechsler J, Mayaud C, Saiag P. Stevens-Johnson syndrome induced by cyclophosphamide: report of two cases. Br J Dermatol. 1996; 135:864-6.
  8. Vajpayee RB, Shekhar H, Sharma N, Jhanji V.Demographic and clinical profile of ocular chemical injuries in the pediatric age group. Ophthalmology. 2014;121:377-80
  9. Ondas O, Keles S. Central corneal thickness in patients with atopic keratoconjunctivitis. Med Sci Monit. 2014 Sep 21;20:1687-90.
  10. De Rojas MV, Dart JK, Saw VP. The natural history of Stevens Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy. Br J Ophthalmol. 2007;91:1048-53.
  11. Morel E, Escamochero S, Cabañas R, Díaz R, Fiandor A, Bellón T. CD94/NKG2C is a killer effector molecule in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Allergy Clin Immunol. 2010;125:703-10.
  12. Inachi S, Mizutani H, Shimizu M. Epidermal apoptotic cell death in erythema multiforme and Stevens-Johnson syndrome. Contribution of perforin-positive cell infiltration. Arch Dermatol. 1997;133:845-9.

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Last updated: 2017-08-09 17:30