Academic literature on the topic 'Symblepharon'

A 5-year old girl had generalized convulsion that lasted 5 minutes following a febrile illness. Two weeks after, she presented with symblepharon involving the medial part of lower lid, bulbar conjunctiva and caruncle. Patient had a successful surgical synechiolysis and fornix maintained with regular rodding. It was concluded that symblepharon and other avoidable complications can follow a poorly managed seizure spell.

A 5-year old girl had generalized convulsion that lasted 5 minutes following a febrile illness. Two weeks after, she presented with symblepharon involving the medial part of lower lid, bulbar conjunctiva and caruncle. Patient had a successful surgical synechiolysis and fornix maintained with regular rodding. It was concluded that symblepharon and other avoidable complications can follow a poorly managed seizure spell.

A 6-year-old female child presented with severe acute ocular chemical burn in the right eye 2 days after injury with cement. She underwent removal of all foreign bodies from the ocular surface and amniotic membrane transplantation. Three months later, she developed unilateral total limbal stem cell deficiency (LSCD) with symblepharon in two quadrants. Three months after the acute injury, the patient underwent autologous simple limbal epithelial transplant in the right eye with one-clock hour of limbus harvested from the left eye. At the same sitting, she underwent symblepharon release in two quadrants of the right eye with conjunctival autograft harvested from the left eye followed by conjunctival graft suturing to the areas of bare sclera in the right eye. One year after surgery, the patient’s visual acuity improved from counting fingers close to face preoperatively to 20/50 (uncorrected) with no recurrence of LSCD or symblepharon.

Eleven patients with the dystrophic form of epidermolysis bullosa underwent ophthalmic assessment to establish the presence, characteristics, and extent of any ocular involvement. Eight patients were found to have eye changes: these included varying degrees of Symblepharon, broadening of the limbus, and corneal opacities. Taken as a group, these changes formed a characteristic pattern. The majority of patients were asymptomatic and the ocular changes appear to be only slowly progressive. Recurrent corneal abrasion and Symblepharon are the most important complications.

A female patient in her late 40s presented with severe visual impairment and a history of oral ulcers, necrolysis of skin and hospitalisation after using gabapentin for neck pain 10 months ago. She was a diagnosed case of Stevens-Johnson syndrome (SJS) with chronic ocular sequelae—with total symblepharon and keratinised lid margins in the left eye and limbal stem cell deficiency and severe dryness in the right eye. Her visual acuity was perception of light in both eyes. She underwent left eye symblepharon release with autologous labial mucous membrane grafts (MMGs) for surface reconstruction and subsequent lid margin MMG for lid margin keratinisation. Best-corrected visual acuity improved to 20/25 with scleral lens in the left eye, which was sustained over 1 year of follow-up. Labial mucosa acts as a useful and easily accessible alternative to conjunctiva in eyes with bilateral severe ocular surface damage and total symblepharon secondary to SJS.

Introducció: El simblèfaron és una afectació de la conjuntiva cicatricial que pot ser evolutiva i de maneig molt frustrant. No s’ha establert un criteri consensuat pel seu tractament. La bibliografia actual presenta limitacions, es tracta habitualment de sèries de casos amb pocs pacients, d’estudis majoritàriament retrospectius i observacionals, s’utilitzen criteris no consensuats i els resultats són difícils d’extrapolar. Es planteja un estudi d’investigació per a determinar la clínica, etiologia, presentació, tractament, pronòstic i seguiment del simblèfaron. Material i mètodes: El disseny de l’estudi és retrospectiu, longitudinal, observacional i descriptiu. S’han inclòs pacients amb diagnòstic de simblèfaron visitats entre el 2008 i el 2013. La recopilació de les dades s’ha realitzat mitjançant la base de dades d’arxius, recerca d’històries clíniques i documents fotogràfics. S’ha fet una recopilació de les variables de filiació, demogràfiques i clíniques per cada pacient. S’ha inclòs l’etiologia del simblèfaron, les variables de localització i extensió, la hiperèmia conjuntival associada, l’afectació corneal, el grau de gruix del simblèfaron, la capacitat d’oclusió palpebral, el grau d’afectació de la motilitat ocular i la repercussió estètica. S’han fet anàlisis prequirúrgiques i postquirúrgiques per a definir factors pronòstics. S’han valorat el seguiment, les recidives i les complicacions. Resultats i conclusions: S’han revisat 255 pacients amb simblèfaron. Es presenta en una major proporció d’homes, en una relació de 1,5 sobre 1. Els homes presenten més causes d’origen traumàtic, sobretot per causticacions i traumatismes mecànics, amb una edat mitjana de presentació de 39 anys. Les dones presenten més causes d’origen no traumàtic, sobretot per pterigi, amb una edat mitjana de presentació de 40 anys. La forma de presentació clínica més habitual és amb afectació unilateral, a fòrnix inferior, amb lleu hiperèmia conjuntival, afectació corneal, mínim engruiximent, afectació de la motilitat, lleu repercussió estètica i sense lagoftàlmia. El tractament quirúrgic implica la millora clínica de totes les variables estudiades, essent l’afectació corneal la de millor resposta quirúrgica i l’afectació de la motilitat la de pitjor resposta quirúrgica amb un molt baix grau de recidives, majoritàriament solucionables. La causa i l’edat de presentació representen un factor pronòstic. Discussió: El treball actual representa el primer estudi d’investigació que analitza de manera global variables clíniques referents al simblèfaron i determina factors pronòstics. És el primer estudi que aporta dades respecte clínica, etiologia, presentació i tractament en l’àrea d’estudi. Per altra banda presenta limitacions relacionades bàsicament pel tipus de disseny retrospectiu i per la presència de criteris terapèutics no consensuats. Els resultats es comparen amb altres estudis publicats, encara que les conclusions són difícils d’extrapolar. Són necessaris més estudis per determinar l’epidemiologia, la clínica, els factors pronòstic i el tractament del simblèfaron. Divulgació financera: No hi ha cap interès al respecte.<br>Introduction: Symblepharon is a disease of the cicatricial conjunctiva that can be evolutionary and with a very frustrating approach. There is no consensus criterion for its treatment. The current literature presents limitations, it is usually a series of cases with few patients, mostly retrospective and observational studies, they use non-consensual criteria, and the results are difficult to extrapolate. We present a research study with the objective of determining the most relevant clinical aspects regarding clinical, etiology and presentation, treatment, prognosis and follow-up of symblepharon. Material and methods: The study design is retrospective, longitudinal, observational and descriptive. Patients with a diagnosis of symblepharon visited between 2008 and 2013 have been included. Data collection has been done through the database of files, the search of medical records and photographic documents. A compilation of the affiliation, demographic and clinical variables for each patient has been made. The etiology of symblepharon, the localization and extension variables, associated conjunctival hyperemia, corneal involvement, the degree of thickness of the symblepharon, palpebral occlusion capacity, the degree of involvement of ocular motility and aesthetic repercussion have been included. Pre-operative and post-surgical analyses have been performed to define prognostic factors. Follow-up, recurrences, and complications have been assessed. Results and conclusions: 255 patients with symblepharon have been reviewed. Symblepharon occurs in a greater proportion of affected men, in a ratio of 1.5 out of 1. Men present more causes of traumatic origin, mainly due to burns and mechanical injuries, with the appearance of a mean of 39 years. Women have more causes of non-traumatic origin, specially pterygium, with onset after 40 years. The most common form of clinical presentation is unilateral affection, inferior fornix, with mild conjunctival hiperemia, corneal involvement, minimal thickening, impaired motility, mild aesthetic repercussion and no lagophthalmos. Surgical treatment involves the clinical improvement of all the variables studied, with corneal involvement being the best surgical response and the involvement of the motility of the worst surgical response with a very low relapse rate, mostly solvable. The etiology and the age at onset represents a prognostic factor. Discussion: The present work represents the first research study that analyzes globally clinical variables related to the symblepharon and determines prognostic factors. It is the first study that provides data regarding clinical, etiology, presentation and treatment in the study area. Nevertheless, there are limitations related to the type of design, retrospective, and the presence of non-consensual therapeutic criteria. The results are compared with other published studies, although the conclusions are difficult to extrapolate. Further studies are needed to determine the epidemiology, clinical, prognostic factors, and treatment of the syndrome. Financial Disclosure: There is no interest in this.