By Dr. Hemali Kanabar | July 9, 2025
🩺 What is Symblepharon?
Symblepharon refers to an adhesion between the palpebral conjunctiva (the lining of the eyelid) and the bulbar conjunctiva (the surface of the eyeball). It may be partial or complete, and severely limits the mobility of the eye and eyelid, potentially leading to visual impairment, discomfort, and cosmetic concerns.
🔍 Clinical Presentation
Patients with symblepharon may present with:
- Restricted eye movements
- Incomplete lid closure (lagophthalmos)
- Dry eye symptoms or exposure keratopathy
- Cosmetic disfigurement
- Diplopia (if extensive restriction)
- Recurrence after previous release procedures
On examination, the adhesion becomes evident when trying to retract the eyelid or move the globe – a band of tissue tethers the surfaces.
⚠️ Common Causes
Symblepharon is not a disease but a consequence of various ocular insults:
| Etiology | Examples |
|---|---|
| Chemical Injuries | Acid/alkali burns (e.g. lime, battery acid) |
| Thermal Burns | Firecracker injuries, hot liquids |
| Cicatrizing Conjunctivitis | Stevens-Johnson Syndrome, Ocular Cicatricial Pemphigoid |
| Trauma or Surgery | Post-enucleation, conjunctival grafting, lid surgery |
| Infections | Severe membranous conjunctivitis |
| Radiation Therapy | After orbital irradiation |
🔬 Classification (Optional for FRCOphth/OSCE)
- By Extent:
- Anterior (limited to fornix)
- Posterior (involving deeper tissue planes)
- By Location:
- Inferior, superior, medial, lateral
📷 Diagnosis
Diagnosis is primarily clinical. A slit-lamp exam or fornix evaluation reveals the adhesion.
🧰 Useful tools:
- Lid retractors for detailed examination
- Scleral shell or glass rod to break minor adhesions
- Imaging (rarely needed) for surgical planning
🛒 Useful instruments – Moorfield Conjunctival Forceps, Desmarres retractors
⚙️ Management
Treatment depends on the cause, severity, and functional impact.
✅ Conservative (for mild or early cases):
- Lubrication – Artificial tears and ointments
- Mechanical stretching – Use of glass rod or scleral shell
🏥 Surgical:
- Symblepharon release – Separation of adhesions
- Amniotic membrane graft (AMG) or conjunctival autograft
- Buccal mucosal graft (for large defects)
- Use of symblepharon rings or conformers post-op to prevent recurrence
- Adjunctive Mitomycin C – To reduce fibrovascular proliferation
👨⚕️ Prevention is Better…
Preventing symblepharon, especially in chemical burns, involves:
- Early and aggressive irrigation
- Frequent fornix sweeping
- Topical steroids (with care)
- Lubricants and Vitamin A
📚 High-Yield FRCOphth/OSCE Tip
“If a station involves a patient with restricted ocular movements and a history of ocular burns or SJS, always suspect symblepharon. Mention fornix evaluation, prevention of recurrence with conformers, and possible need for mucous membrane grafting.”
💡 Key Takeaways
- Symblepharon is adhesion between lid and globe conjunctiva.
- Most often caused by chemical injury or cicatrizing conjunctivitis.
- Treatment ranges from lubrication to complex reconstructive surgery.
- Early intervention is key to preventing long-term complications.
Read More – https://eyewiki.org/Symblepharon