Symblepharon: A Review of Etiology, Clinical Features, and Management Strategies

A symblepharon is an adhesion between the bulbar and the palpebral conjunctiva and is a manifestation of the loss of conjunctival redundancy. It occurs due to conjunctival scarring, most commonly resulting from trauma or chronic inflammation. Vision can be affected either if the symblepharon is present along with primary keratopathy and limbal stem cell deficiency, or if it is extensive leading to secondary corneal involvement. There is currently no medical treatment for symblepharon, nor can its occurrence be fully prevented. Surgical management is often necessary in cases associated with chronic cicatrizing conjunctivitis.

This review aims to summarize the etiology, clinical presentation, and management strategies for ocular symblephara. Methods: A comprehensive literature search was conducted using PubMed database, identifying published studies addressing ocular symblephara and their management. Mechanisms of symblephara formation and emerging treatment modalities for prevention of symblephara were also evaluated.

Surgical approaches to symblephara management involve excision of the fibrotic tissue and placement of mechanical barriers or biological tissue substitutes such as amniotic membranes, conjunctival autografts, and oral mucous membrane grafts. Surgical intervention is recommended for symblepharon in cases where cosmesis is a concern, the visual axis is affected, or in extensive cases before procedures such as cataract surgery, limbal stem cell transplantation, or keratoprosthesis surgery, as well as to facilitate scleral contact lens fitting. Management also involves addressing the underlying disease that led to symblepharon formation. The recurrence rate of symblepharon following surgical treatment is higher in eyes with Stevens-Johnson syndrome or mucous membrane pemphigoid compared to those with ocular chemical burns. Further research is needed to explore preventive strategies such as anti-fibrotic agents and potential medical treatment for symblepharon.