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Symblepharon

A symblepharon is a fibrous tract that connects bulbar conjunctiva toconjunctiva on the eyelid.

When do symblepharon occur?

• Cicatricial pemphigoid; auto-immune disease which affects mucus membranes such as the mouth and oral pharynx, conjunctiva, nares and genitalia.
• Atopic keratoconjunctivitis: This is a hypersensitivity to environmental allergies including asthma, rhinitis, dermatitis and eczema.
• Trichiasis: A lid abnormality in which eyelashes are misdirected towards the eyeball. These misdirected lashes might often be the lead to of scarring.
• Toxic epidermal necrosis (TEN): A potentially life-threatening disorder which is commonly drug-induced.

Stevens Johnson Syndrome

Characteristics:

• Equal age and sex distribution
• Disease associated with a 5-15% mortality rate
• Ocular involvement in 50%
• Associated with various infections and medications most notably sulfa

Pathogenesis:

• Angiitis–>Erythematous lesion–>Bullae–>Rupture–>Scar

Prodrome:

• Fever, chills, and headache
• 7 days later bullous mucosal lesions develop

Sequelae:

• Problems are related to the destruction of Goblet cells and a lack of conjunctival mucus which leads to keratinization and scarring.
• Lid scarring with symblepharon
• Corneal scarring
• Keratitis sicc

Burns

Erythema multiforme:

This is an acute multi-cutaneous hypersensitivity reaction

What are the treatment options?

Why use Amniotic membrane? Because it:

• facilitates epithelialization
• maintains normal epithelial phenotype (with goblet cells when performed on conjunctiva)
• reduce inflammation, vascularization and scarring.

The use of human amniotic membrane for the surgical treatment of an ocular surface disorder was initially reported by de Rotth ¹⁶ in 1940. During the 1990s, the role of amniotic membrane transplantation in treating a variety of ocular surface defects and abnormalities has been revived.