Symblepharon

What is symblepharon?

Symblepharon is an eye condition that affects the conjunctiva of your eye. That’s the thin, clear membrane that covers the white part of your eye (the sclera). It also lines the insides of your eyelids. A symblepharon (plural, symblephara) is an adhesion between these two layers of your conjunctiva.

Symblepharon happens when severe inflammation makes your eye tissues swell and stick together. After inflammation, scars can form, fusing the layers permanently. You may have one or more adhesions. Chronic inflammation in your eye can cause repeat episodes of symblepharon.

What are the clinical signs and symptoms of symblepharon?

You can often see a symblepharon in your eye. It looks like a band of tissue connecting your inner eyelid to your eyeball. If you can’t see it directly, you might notice that your eyelid doesn’t open all the way, or that your eyeball can’t move in all the ways it used to. Other side effects of symblepharon can include:

• Ptosis: Symblepharon may pull your eyelid down, making it droop.
• Entropion: Symblepharon may turn your eyelid inward toward your eye.
• Lagophthalmos: Symblepharon may prevent your eyelid from closing all the way.
• Diplopia: Limited eyeball movement may cause double vision.

Some of these side effects may lead to eye irritation and related symptoms, including:

• Redness.
• Light sensitivity.
• Tearing.
• Dry eye.

What causes symblepharon?

Severe or long-lasting inflammation of your conjunctiva (conjunctivitis) can lead to symblepharon. Your conjunctiva lines the insides of your eyelids and the white part of your eyeball. Severe inflammation and swelling can make these tissues stick together. Scarring follows, making the adhesions permanent.

Sometimes, your cornea may also be inflamed (keratoconjunctivitis). That’s the clear membrane that covers your iris. This can lead to adhesions between your conjunctiva and cornea. Conditions that can cause severe conjunctivitis or keratoconjunctivitis include infections, injuries and autoimmune diseases.

Some examples include:

• Ocular herpes.
• Trachoma.
• Adenoviral keratoconjunctivitis.
• Chemical burns.
• Complications of eye surgery.
• Adverse reaction to eye medications.
• Graft vs. host disease.
• Ocular cicatricial pemphigoid.
• Mucous membrane pemphigoid.
• Bullous pemphigoid.
• Erythema multiforme.
• Stevens-Johnson syndrome.
• Lichen planus.
• Scleroderma.
• Sarcoidosis.
• Granulomatosis with polyangiitis.

What are the serious complications of symblepharon?

Symblepharon can irritate your eye by interfering with blinking or by turning your eyelashes in toward your eye (trichiasis). A symblepharon that involves your conjunctiva fornix may obstruct your tear system. A symblepharon that restricts your eye movement, or that attaches to your cornea, can cause vision loss.

How is symblepharon diagnosed?

Your eye care provider can diagnose symblepharon with an eye exam. They can give you eye drops to make it more comfortable. During your exam, they’ll carefully observe which tissues are attached, and where. They’ll also look for complications that can occur with the type of symblepharon you have.

If they don’t already know what’s causing your symblepharon, your provider might suggest additional tests to find out, like an eye swab or a blood test. Some of the possible causes will go away with treatment, but others are chronic conditions that may continue to occur and need ongoing treatment.

What is the treatment for symblepharon?

Symblepharon is easier to prevent than to treat. If your provider knows in advance that you’re prone to symblephara (plural of symblepharon) or you have a condition that may cause them, they can work to prevent them. They do this by treating your underlying condition and keeping the surfaces of your conjunctiva separated when inflamed.

Medical treatment for your underlying condition may include:

• Corticosteroids for inflammation.
• Antibiotics or antivirals for infections.
• Immunomodulators for autoimmune disease.

You may take medications orally or as drops in your eye. Once the inflammation in your eye has calmed down, your provider may apply a dressing of amniotic membrane to help prevent or minimize scarring. It may be a disk that sticks on like a contact lens, or they might attach it surgically to your eye in some cases.

Symblepharon surgery

If your provider can’t prevent symblepharon or they’re treating you after the fact, you may need surgery to remove the adhesions. Surgery for symblepharon varies depending on how severe it is. You may only need a simple procedure, or you may need complex oculoplastic surgery. Methods may include:

• Symblepharon release: This simply means disconnecting the adhesions between your conjunctiva layers. Your surgeon might also need to remove scar tissue from your conjunctiva.
• Tissue graft: Surgeons may use tissue from elsewhere on your eyeball or from another mucous membrane, like the inside of your lip, to replace tissue they remove from your eye.
• Oculoplastic reconstruction: If your symblepharon affected your conjunctiva fornix, your surgeon might need to reconstruct it. If it affected your cornea, you might need keratoplasty.

How can I prevent symblepharon?

If you have severe conjunctivitis that doesn’t seem to be improving, make sure to tell your healthcare provider. Severe inflammation will make your eye red, swollen and painful. While a mild case will usually go away on its own, a severe case needs medical attention to prevent complications like symblepharon.

What’s the prognosis with symblepharon?

Your prognosis (outlook) will depend on how severe your condition is, how much of your eye tissue is involved and how well you respond to the treatment. Some cases heal completely, while others can do lasting damage. Some people with chronic diseases have repeat episodes that cause progressive scarring.

A note from Cleveland Clinic

A symblepharon is often asymptomatic (without symptoms). Your provider might only discover it during a routine eye exam. If it hasn’t caused symptoms yet, it’s unlikely to cause much harm. The most important thing is to determine what’s causing your symblepharon and prevent further scarring.