Symblepharon: Causes, Types and Treatments

Symblepharon, a potentially challenging eye condition, is an anomaly of the “conjunctive”, the membrane in the eye, which drapes the inner surface of the eyelids and envelops the eye's white sclera. When symblepharon occurs, the conjunctiva either adheres to itself or the cornea, creating a web-like connection between the eyelid and the eyeball. Symblepharon could be caused by diverse factors and its impact can encompass a spectrum of complications ranging from restricted eye movement to discomfort and vision impairments. In this article, we delve into the intricacies of symblepharon, exploring its causes, types, and the diverse therapeutic approaches aimed at restoring ocular health and function. Let’s begin. 

What are the types of symblepharon?

Symblepharon can be classified into different types based on its extent, location, and severity. The primary types include:

1. Simple symblepharon: Adhesions occur between the conjunctiva of the eyelid and the conjunctiva covering the eyeball, and may be limited to a small area.
2. Cicatricial symblepharon: Involves more extensive adhesions, and often results from conditions that cause significant inflammation and scarring of the conjunctiva.
3. Fornix symblepharon: Specifically refers to adhesions forming in the conjunctival fornices, which are the recesses or pockets between the eyeball and the eyelids.
4. Partial symblepharon: Partial symblepharon involves adhesions covering only a portion of the conjunctival surface. The extent and location can vary.
5. Total symblepharon: The most severe form of symblepharon, in which adhesions cover the entire surface of the eye. 

Read more - Eye Flu: Symptoms, Precautions, and At-Home Remedies

What are the signs and symptoms of symblepharon?

Symblepharon can have various signs and symptoms, and their severity varies depending on factors such as the underlying cause and the extent of adhesions. Common signs and symptoms of symblepharon include:

• Eye redness: The affected eye may appear red or inflamed due to the irritation caused by the adhesions.
• Foreign body sensation: Individuals with symblepharon may experience a persistent feeling of having a foreign body or something stuck in the eye.
• Eye pain or discomfort: Discomfort, ranging from mild irritation to more pronounced pain, can be associated with symblepharon.
• Decreased vision: Depending on the location and severity of adhesions, symblepharon can lead to a reduction in visual acuity.
• Limited eye movement: Adhesions between the conjunctiva and the cornea or between different parts of the conjunctiva can restrict normal eye movement.
• Tearing or excessive eye dryness: Changes in tear flow can occur, leading to either excessive tearing or, conversely, dryness and discomfort.
• Photophobia (sensitivity to light): Individuals with symblepharon may become more sensitive to light, experiencing discomfort when exposed to bright lights.
• Visible adhesions: In some cases, you may be able to visually observe the adhesions or webs connecting the eyelid to the eyeball.

Note: As the aforementioned symptoms can be indicative of various eye conditions, a comprehensive eye examination by an eye specialist is essential for an accurate diagnosis. 

What causes symblepharon?

The specific cause of symblepharon may vary from person to person, and in many cases, it may be a combination of factors. Here are some common causes of symblepharon:

• Injuries: Trauma to the eye, such as chemical burns, thermal injuries, or direct physical trauma, can lead to the development of symblepharon. During the healing process, the conjunctiva may adhere to itself or the cornea.
• Inflammatory disorders: Certain inflammatory conditions involving inflammation of the conjunctiva can lead to scarring, causing symblepharon.
• Infections: Severe or chronic eye infections may cause inflammation and scarring of the conjunctiva, potentially leading to symblepharon.
• Autoimmune diseases: Some autoimmune diseases, where the body's immune system mistakenly attacks its own tissues, can affect the conjunctiva and contribute to the development of symblepharon.
• Surgery or medical procedures: Certain eye surgeries or medical procedures may lead to scarring and adhesion of the conjunctiva, increasing the risk of symblepharon.
• Genetic factors: In some cases, there may be a genetic predisposition to developing symblepharon, although this is less common.

It's essential for individuals experiencing symptoms or complications related to their eyes to consult with an ophthalmologist (eye specialist) for a thorough evaluation and diagnosis. 

What are the complications of symblepharon?

If left untreated, symblepharon can lead to several complications, depending on its severity and the extent of adhesions. Potential complications include:

• Visual impairment: In cases where symblepharon causes significant adhesions, there may be a reduction in visual acuity, potentially leading to blurred or distorted vision.
• Chronic discomfort: Individuals with symblepharon may experience persistent discomfort, including sensations of dryness, irritation, or a foreign body in the eye.
• Corneal complications: Severe cases of symblepharon can impact the cornea, potentially leading to corneal abrasions, ulcers, or other corneal problems.
• Conjunctival scarring: The scarring associated with symblepharon can change the conjunctiva's structure, impacting tear production and the overall eye health.
• Functional impairments: Symblepharon can interfere with the normal functioning of the eyelids and tear film, contributing to issues such as dry eye syndrome.
• Psychosocial impact: The visible nature of symblepharon and its potential impact on appearance can have psychosocial implications, affecting a person's vision of self.

How is symblepharon treated?

The treatment of symblepharon depends on the underlying cause, the severity of adhesions, and the resulting complications. In severe cases, a multidisciplinary approach involving ophthalmologists, corneal ulcer specialists, and other healthcare professionals may be necessary to address complications and provide comprehensive care. Here are some common approaches to managing symblepharon:

Conservative measures

• Lubrication: Lubricating eye drops or ointments may be prescribed to alleviate dryness and provide relief from discomfort.
• Topical steroids: In some cases, topical steroids may be used to reduce inflammation and prevent further scarring. However, their use is often carefully monitored due to potential side effects.

Physical therapy

Gentle manipulation and stretching exercises may be employed to prevent or reduce adhesions. This can involve using special devices or tools to separate the adhesions and improve eye movement.

Anti-fibrotic medications

Anti-fibrotic medications are drugs that aim to inhibit or modulate the fibrotic (scar tissue) response in tissues. In the context of symblepharon treatment, these medications are used to prevent or reduce excessive scar formation, which can contribute to adhesions between the conjunctiva and other ocular structures.

• Corticosteroids: Topical corticosteroid eye drops or ointments may be prescribed to reduce inflammation and suppress the immune response, thereby minimizing scar formation. 
• Mitomycin C: Another anti-fibrotic agent that may be employed is Mitomycin C, which works by inhibiting the growth of fibroblasts, the cells responsible for forming connective tissue.
• Combined approaches: Anti-fibrotic medications are sometimes used in conjunction with other treatment modalities, such as surgical procedures or physical therapy, to optimize outcomes.

It's important to note that the use of anti-fibrotic medications requires close monitoring by a doctor, and the treatment plan may be adjusted based on the patient's response and any potential side effects. 

Surgical intervention

In some cases, surgical procedures may be necessary to release adhesions and restore normal anatomy. This can include techniques such as:

• Conjunctival grafts: Recommended in cases where there is a significant loss of conjunctival tissue due to scarring. This involves transplanting healthy conjunctival tissue from one part of the eye or from a donor site to the affected area. 
• Amniotic membrane transplantation: Transplantation of amniotic membrane, obtained from the innermost layer of the placenta, which has anti-inflammatory and anti-scarring properties, thereby help in managing symblepharon and reducing the risk of recurrence.
• Mucous membrane transplantation: In cases where conjunctival tissue is severely compromised, transplantation of mucous membrane tissue from other parts of the body, such as the oral mucosa, may be considered. 

How to prevent symblepharon?

Preventing symblepharon involves addressing the underlying causes and minimizing the risk factors associated with the development of adhesions between the conjunctiva and the cornea. While it may not always be possible to prevent symblepharon, especially in cases of trauma or certain medical conditions, the following measures can help reduce the risk:

• Prompt treatment of eye injuries: Seek immediate medical attention for any eye injuries or trauma, to help minimize scarring and reduce the risk of symblepharon.
• Effective management of eye infections: Promptly treat and manage any eye infections to prevent inflammation and scarring of the conjunctiva.
• Control inflammatory conditions: If someone has an autoimmune or inflammatory condition that affects the eyes, they must work closely with their eye specialist to manage and control the underlying factor. 
• Avoiding harmful substances: Take precautions to avoid exposure to harmful substances that can cause chemical burns or irritation to the eyes. This includes using protective eyewear in situations where there is a risk of exposure to chemicals.
• Proper postoperative care: If someone undergoes eye surgery, they must strictly follow the postoperative care instructions provided by their doctor. 
• Maintain eye hygiene: Practice good eye hygiene by avoiding habits that can lead to eye irritation or infection, such as rubbing the eyes excessively and avoiding the use of expired or contaminated eye drops.
• Addressing dry eye: If someone has signs of dry eye, such as redness or discomfort, consult with an eye specialist as soon as possible, as dry eyes can contribute to ocular surface issues.

While these measures can help reduce the risk of symblepharon, it's important to note that some cases may still occur despite preventive efforts. 

What is the prognosis of symblepharon?

The prognosis of symblepharon varies widely depending on several factors, including the underlying cause, the extent of adhesions, and the effectiveness of treatment. In general, early detection and intervention contribute to better outcomes. Here are some key considerations regarding the prognosis of symblepharon:

• Severity of adhesions: Mild cases with limited adhesions may have a better prognosis compared to severe cases where adhesions cover a larger area of the eye.
• Underlying cause: Addressing and managing the underlying cause of symblepharon is crucial for a favorable prognosis. 
• Timely intervention: Early detection and prompt intervention, whether through conservative measures, physical therapy, or surgical procedures, are associated with better outcomes. 
• Patient compliance: Following the healthcare provider's recommendations and attending follow-up appointments contribute to a more favorable prognosis.
• Complications: Complications such as corneal ulcers, visual impairment, or chronic discomfort can impact the overall prognosis. 
• Individual variability: The overall prognosis can vary among individuals. Some people may experience significant improvement, while others may have lingering symptoms or complications.

Final words

If you or a loved one has been experiencing symptoms such as eye redness, discomfort, limited eye movement, or suspect you may have symblepharon, it is imperative to seek professional guidance without any delay. That’s when you can count on the expertise of the team of ophthalmologists and corneal specialists at Max Hospitals. Equipped with extensive experience and advanced technology, our team is ideally equipped to accurately diagnose and tailor a personalized treatment plan for your specific needs. Schedule a consultation with Max Hospitals to embark on a journey towards improved eye wellness.

Frequently asked questions about symblepharon

Q: Is symblepharon painful?

Yes, symblepharon can be painful, especially in cases where there is inflammation and/or restricted eye movement, or if there are complications such as corneal ulcers.

Q: Can symblepharon recur after treatment?

Yes, in some cases, symblepharon can recur, especially if the underlying cause is not effectively managed or if adhesions reform after surgical intervention. Recurrence may necessitate additional treatment.

Q: Are there any home remedies for symblepharon?

While basic eye care practices such as maintaining good eye hygiene and avoiding habits that can cause eye irritation are important, symblepharon typically requires professional evaluation and treatment, and home remedies are not a substitute for that.

Q: Can symblepharon lead to permanent vision loss?

A: Severe cases of symblepharon, especially if left untreated, can potentially lead to permanent vision impairment. However, with early detection and appropriate intervention, the risk of permanent vision loss can be minimized.

Q: How long does the recovery take after surgical intervention for symblepharon?

A: The recovery time can vary depending on the extent of the surgery and the individual's response to treatment. 

Q: Can children develop symblepharon?

Yes, although symblepharon is more commonly seen in adults, children can develop this condition, especially if they experience severe eye injuries or certain inflammatory conditions.

Q: Can symblepharon be caused by using contact lenses?

Though a rarity, improper use or hygiene related to contact lenses can lead to eye infections and inflammation, which, in extreme cases, may contribute to symblepharon.