Symblepharon Management

No treatment is needed if patients are asymptomatic and if clinical staging of symblepharon does not reveal any pathogenic potential. A symblepharon can potentially be pathogenic if it obliterates the tear meniscus, the reservoir, or lacrimal secretion (leading to dry eye), induces blink-related microtrauma from the lid margin and misdirected lashes due to cicatricial entropion (inciting mechanical irritation), produces exposure keratopathy due to incomplete blink/closure or loss of Bell’s phenomenon (punctuate/ulcerative keratopathy), restricts ocular motility (causing binocular diplopia) or impedes the comfort of contact/scleral lens wear.

Patients with symptoms caused by pathogenic symblepharon should be treated to avoid potential blindness. The treatments start with conventional therapies including frequent lubrication using artificial tears or ointment, punctal occlusion, bandage contact lens (if not contraindicated), scleral lens, and periodic epilation. Systemic immunosuppressive measures should also be initiated for active inflammation in mucous membrane pemphigoid.

If the above measures fail to achieve the desired effects or cannot be instituted (e.g., lens insertion), even if the inflammatory activity is successfully controlled by systemic immunosuppression in the case of mucous membrane pemphigoid, surgical procedures including symblepharon lysis and fornix reconstruction become necessary. This Guide describes our proposed surgical methods, which include intraoperatiave application of mitomycin C (MMC) and sutureless transplantation of a cryopreserved amnion graft.

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