SYMBLEPHARON

In this condition lids become adherent with the
eyeball as a result of adhesions between the palpebral
and bulbar conjunctiva.
Etiology
It results from healing of the kissing raw surfaces
upon the palpebral and bulbar conjunctiva. Its
common causes are thermal or chemical burns,
membranous conjunctivitis, injuries, conjunctival
ulcerations, ocular pemphigus and Stevens-Johnson
syndrome.
Clinical picture
It is characterised by difficulty in lid movements,
diplopia (due to restricted ocular motility), inability
to close the lids (lagophthalmos) and cosmetic
disfigurement.
Fibrous adhesions between palpebral conjunctiva
and the bulbar conjunctiva and/or cornea (Fig. 14.30)
may be present only in the anterior part (anterior
symblepharon), or fornix (posterior symblepharon)
or the whole lid (total symblepharon).
Complications
These include dryness, thickening and keratinisation
of conjunctiva due to prolonged exposure and corneal
ulceration (exposure keratitis).
Treatment
1. Prophylaxis. During the stage of raw surfaces,
the adhesions may be prevented by sweeping a
glass rod coated with lubricant around the
fornices several times a day. A large-sized,
therapeutic, soft contact lens also helps in
preventing the adhesions.
2. Curative treatment consists of symblepharectomy.
The raw area created may be covered by
mobilising the surrounding conjunctiva in mild
cases. Conjunctival or buccal mucosal graft is
required in severe cases.