What is Symblepharon?

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

When do symblepharon occur?

Cicatricial pemphigoid: auto-immune disease which affects mucus membranes such as the mouth and oral pharynx, conjunctiva, nares and genitalia

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
  • Pathogenesis:
    • Angiitis-->Erythematous lesion-->Bullae-->Rupture-->Scar
  • Prodrome:
    • Fever, chills, and headache
    • 7 days later bullous mucosal lesions develop
  • Sequelae:
    • 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
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.

Surgery Details

The goal of ocular surface reconstruction is to reconstruct a functional ocular surface. Buccal mucosa or preserved amniotic membrane can be employed.

Mucous membrane grafting has rarely been used as a treatment for unilateral chemical injury and is used in desperate cases of bilateral injury where advancement of Tenon's capsule is not possible and allograft limbal tissue is not available.

Amniotic membrane transplantation provides a favorable extracellular matrix substrate for epithelial migration and adhesion. This procedure is not effective in replacing the normal stem cells. An amniotic membrane transplant is often one step in a sequence of procedures.

Steps in the surgical technique include:

  • Remove scar tissue of the ocular surface
  • Perform superficial keratectomy
  • Recess the residual conjunctival free border toward the fornix
  • Drape the amniotic membrane over the denuded ocular surface
  • Suture graft to the free conjunctival tissues
  • Perform partial tarsorrhaphy to prevent graft movement
  • Use a conformer to prevent the adhesion of mucosal membranes

Mechanisms of Action Recent reports indicate that the potential mechanisms of action may include the following:

The basement side of the membrane is an ideal substrate for supporting the growth of epithelial progenitor cells by prolonging life span and maintaining clonogenicity . This action supports why amniotic membrane transplantation can be used to expand remaining limbal stem cells and corneal transient amplifying cells during the treatment of partial limbal (stem cell) deficiency . In addition, it also explains why amniotic membrane transplantation can be used to facilitate epithelialization for persistent corneal epithelial defects with stromal ulceration . In tissue cultures, amniotic membrane supports limbal epithelial cells grown from explant cultures and the resultant epithelial cells-amniotic membrane can be transplanted back to reconstruct the damaged corneal surface . The amniotic membrane can also be used to promote non-goblet cell differentiation of the conjunctival epithelium . Conjunctival goblet cell differentiation is further promoted by coculturing them with conjunctival fibroblasts on the same side of the basement membrane . These data supports why conjunctival goblet cell density is promoted following amniotic membrane transplantation in vivo

The stromal side of the membrane contains a unique matrix component that suppresses TGF-b signaling, proliferation and myofibroblast differentiation of normal human corneal and limbal fibroblasts . This action explains why amniotic membrane transplantation helps reducing scars during conjunctival surface reconstruction, preventing recurrent scarring after pterygium removal , and reducing corneal haze following PTK and PRK . Although such an action is more potent when fibroblasts are in contact with the stromal matrix, a lesser effect is also noted when fibroblasts are separated from the membrane by a distance, suggesting that some diffusible factors might also be involved in addition to the insoluble matrix components in the membrane. In line with this thinking, several growth factors have been identified in the amniotic membrane .

The stromal matrix of the membrane can also exclude inflammatory cells by rendering them into rapid apoptosis , and contains various forms of protease inhibitors . This action explains why stromal inflammation is reduced after amniotic membrane transplantation and corneal neovascularization is mitigated , actions important for preparing the stroma for supporting limbal stem cells to be transplanted either at the same time or later . This action also explains why keratocyte apoptosis can be reduced and hence the stromal haze.

- Anophthalmia is a medical term used to describe the absence of the globe and ocular tissue from the orbit. - This was first reported more than 400 years ago, yet it is only recently that significant reconstructive options became available. - There are many reasons why one might lose an eye. - Surgeries which result in anophthalmos
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What is Blepharoplasty?
- Your eyes including your eyelids, are perhaps one of the first things people notice in you. This makes your eyes and eyelids one of the most important components for an appealing facial expression and aesthetic appearance. Any visible change in the shape or size of the orbital or periorbital region can spoil the look of your face.
- As you age and grow older, your eyelids may become ‘droopy’ or ‘baggy’ due to the stretching of your eyelid skin and gradually decreasing tone of your eyelid muscles. Your droopy eyelids and brow together cut a sorry figure for your face making you look tired, sleepy and haggard, further leading to eyelid or brow straining or both. In extreme cases, your saggy, baggy eyelids can even obstruct your vision, particularly peripheral vision causing difficulty in reading or driving.
- Blepharoplasty ensures cosmetic or functional corrections to the area around your eyes to enhance your look or to correct any abnormalities in function.
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- Blepharospasm is defined as an abnormal, involuntary, sustained and forceful closure or twitching of the eyelids. It is derived from the Greek word ‘blepharon’ which means eyelid, and ‘spasm’ which is an uncontrolled muscle contraction. Blepharospasm is usually associated with headache, eyebrow strain and occasionally loss of vision.
- Isolated blepharospasm is rare and represents a minority of patients presenting with blepharospasm. Blepharospasm is commonly associated with lower facial spasms as part of a syndrome or disease complex. Some examples are:
   - Meige Syndrome: Characterized by spasm of the eyelids and midface.
    - Brueghel’s Syndrome: Presents with blepharospasm and marked spasms in the lower face and neck.
    - Segmental Cranial Dystonia: In addition to the usual spasms of the eyelids and facial muscles it is associated with spasms along distribution of various cranial nerves, most frequently involving the Facial Nerve.
    - Generalized Dystonia: Presents with spasms across various body parts in addition to blepharospasm and facial spasms.
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Brow Lift
A forehead lift, also known as a browlift or browplasty, is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or to remove the deep worry lines that run across the forehead and may portray to others anger, sternness, hostility, fatigue or other unintended emotions
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Congenital anomolies include :
- Eyelid Disorders
- Orbital Disorders
- Congenital Ptosis
- Congenital Nasolacrimal Duct Obstruction

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Dry Eye
What is Dry Eye?
- Dry eye is a reduction in your eye’s ability to produce sufficient natural tears.
- Insufficient tear production can lead to irritation and pain, and even scarring of the cornea (the transparent part of the eye that covers the pupil and iris).
- Many people will experience dry eye symptoms at some point in their lives.
- Often due to environmental factors such as indoor heating or air conditioning, it can also be caused by occupational factors such as prolonged computer use.
- Dry eye symptoms can affect anyone.
- Some of the symptoms of dry eye include a burning sensation or gritty feeling in the eyes. You may also experience decreased tolerance to contact lens wear or sensitivity to light.
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Eyelid Laxity
- Eyelids protect your eyes from any foreign bodies while keeping them lubricated throughout. Any alteration in the shape, position or function of your eyelids can predispose your eyes to a plethora of ailments or interfere with our vision.
Our eyelid is a complex structure consisting of three theoretical layers:
   - Anterior Layer contains the skin and orbicularis muscle
   - Middle Layer contains the orbital septum and eyelid retractors
   - Posterior Layer contains tarsus and conjunctiva.

- Eyelid malpositions include any unnatural or incorrect positioning and orientation of eyelids due to various factors that influence any of the three layers of the eyelids. They may be caused due to ageing, trauma, scarring, birth defects or medical disease involving any or all of the three layers.
- The most common forms of eyelid malposition are eyelid retraction, ptosis, entropion and ectropion.
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The world of cosmetic surgery has advanced tremendously over the last two decades. New procedures have emerged that can make an individual look and feel younger in a matter of a few minutes. Amongst the vast number of cosmetic procedures currently available, the face lift is a commonly performed one that is sought after by both men and women. Here we shall take a look at this procedure in a little more detail.

- What is a face lift?    - A face lift is called a rhytidectomy in the world of medicine. It involves tightening the muscles of the face and smoothening of the skin so that the face appears younger.    - However, it must be remembered that a face-lift is not an anti ageing solution.
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Lacrimal System
- The lacrimal gland produces tears which enter into the "duct" that drain the tears from the eye into the nose. The most common symptoms are If one has a plugged up "tear duct," not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected.    (1) excess tearing (tears may run down the face) and    (2) mucous discharge - This may lead to recurrent red eyes and infections. - The excessive tearing can also produce secondary skin changes on the lower eyelids.
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Patients with lagophthalmos have an inability to close eyelids. This may occur, for instance, in patients with Thyroid eye disease.
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LATISSE® makes lash growth possible because of its active ingredient: bimatoprost. Although the precise mechanism of action is not known, research suggests that the growth of eyelashes occurs by increasing the percent of hairs in, and the duration of, the anagen (or growth) phase. Lashes can grow longer, thicker and darker because bimatoprost can also prolong this growth phase.
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Orbital Tumors
- Orbital Tumor is any tumor that occurs within the orbit of the eye. The orbit is a bony housing in the skull about 2 inches deep that provides protection to the entire eyeball except the front surface. It is lined by the orbital bones and contains the eyeball, its muscles, blood supply, nerve supply, and fat.
- Tumors may develop in any of the tissues surrounding the eyeball and may also invade the orbit from the sinuses, brain, or nasal cavity, or it may metastasize (spread) from other areas of the body. Orbital tumors can affect adults and children. Fortunately, most are benign.
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- Ptosis is an abnormally low position (drooping) of the upper eyelid
- Ptosis occurs when the muscles that raise the eyelid (levator and Müller's muscles) are not strong enough to do so properly.
- It can affect one eye or both eyes and is more common in the elderly, as muscles in the eyelids may begin to deteriorate.
- Compare with dermatochalsis (extra skin and fat)
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Skin Rejuvination
A radiant, smooth, youthful skin is the essence of beauty and trendy looks. Skin care routine highly contributes in the slowing down of rate of aging of the skin. Choosing the right skin care products for your skin type enhances your beauty keeping the skin cleansed, moisturized and well toned. Use of superficial skin resurfacing treatments to counter fine lines and wrinkles, acne scars and blemishes before they deepen ensures skin rejuvenation.
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Skin Tumors
Cancer of the eyelid, like any other cancer, can be a worrying thing. Treatments are variable and depend on the type of cancer. In this article, we shall take a brief look at the different kinds of eyelid tumors.
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A symblepharon is a fibrous tract that connects bulbar conjunctiva to conjunctiva on the eyelid.
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Graves' disease is an autoimmune disease.
It most commonly affects the thyroid, causing it to grow to twice its size or more (goiter), be overactive, with related hyperthyroid symptoms such as increased heartbeat, muscle weakness, disturbed sleep, and irritability. It can also affect the eyes, causing bulging eyes (exophthalmos).
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Eye injuries are extremely common with over 2 million cases reported every year that require medical treatment. Blindness in one eye is most commonly due to cataract and this is followed closely by eye injuries. In addition, in children, injury to the eye is a recognized as the most common cause of blindness in one eye that is not due to a birth defect.
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