Stages of Symblepharon

For each symblepharon, the location is assigned by using “U: upper lid” or “L: lower lid”, and “N: nasal”, “M: middle” or “T: temporal”.

The severity is graded according to the following three parameters:

1. The shortest vertical length of symblepharon measured from the limbus to the lid margin of the foreshortened fornix. It is graded as “Mild” (Fig. 2A) if the length is greater than the palpebral conjunctiva, as “Moderate” (Fig. 2B) if the length is greater than the tarsal conjunctiva but shorter than the palpebral conjunctiva, or as “Severe” (Fig. 2C) if the length is shorter than the normal tarsal conjunctiva.

2. The longest horizontal width of symblepharon as compared to the length of the eyelid. It is graded as “Mild” if the width is less than 1/3 (Fig. 3A), as “Moderate” if the width is greater than 1/3 but less than 2/3 (Fig. 3B), or as “Severe” if the width is greater than 2/3 of the lid (Fig. 3C).

3. The severity and the location of the inflammatory activity of the symblepharon. The inflammatory activity is graded as “0” if absent (Fig. 4A), “1+” if mild (Fig. 4B), “2+” if moderate (Fig. 4C), or “3+” if severe (Fig. 4D) as judged by the vascularity and the presence or absence of whitish scar tissue. The location of most active inflammation is further specified as “L: limbal”, “F: forniceal”, or “T: tarsal”.

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