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Symblepharon

A symblepharon is pathologic condition when the bulbar and palpebral conjunctiva form an abnormal adhesion to each other.

When do symblepharon occur?

Symblepharon typically occurs under the following conditions:

• Cicatricial pemphigoid: auto-immune disease which affects mucus membranes such as the mouth and oral pharynx, conjunctiva, nares and genitalia.
• Atopic keratoconjunctivitis: hypersensitivity to environmental allergies including asthma, rhinitis, dermatitis and eczema.
• Trichiasis: lid abnormality in which eyelashes are misdirected towards the eyeball, which can lead to 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 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

Erythema multiforme is an acute multi-cutaneous hypersensitivity reaction. It is considered to be an allergic reaction to medicine or an infection. Symptoms are symmetrical, red, raised skin areas that can appear all over the body. They appear to be more noticeable on the fingers and toes.

Treatment

Amniotic membrane is thought to treat this condition 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.