A symblepharon is a fibrous tract that connects bulbar conjunctiva toconjunctiva on the eyelid.

Cicatricial pemphigoid; auto-immune disease which affects mucus membranes such as the mouth and oral pharynx, conjunctiva, nares and genitaliaWhen do symblepharon occur?

Atopic keratoconjunctivitis: This is a hypersensitivity to environmental allergies including asthma, rhinitis, dermatitis and eczema.

Trichiasis: A lid abnormality in which eyelashes are misdirected towards the eyeball. These misdirected lashes may often be the result of scarring.

Toxic epidermal necrosis (TEN): A potentially life-threatening disorder which is commonly drug-induced.

Stevens Johnson Syndrome

Characteristics:

Equal age and sex distribution

Severe disease associated with a 5-15% mortality rate

Ocular involvement in 50%

Associated with various infections and medications most notably sulfa

Ocular involvement in 50%

Pathogenesis:

Angiitis-->Erythematous lesion-->Bullae-->Rupture-->Scar

Prodrome:

Fever, chills, and headache

7 days later bullous mucosal lesions develop

Problems are 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

Sequelae:

Burns

Erythema multiforme: This is an acute multi-cutaneous hypersensitivity reaction

What are the treatment options?

Why use Amniotic membrane? 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 first 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.

Op.Dr.Ahmet UMAY (Brıstol Unıversıty/UK)


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