Effect of Postoperative Subconjunctival Corticosteroid Injections in a Multimodal Approach for the Treatment of Severe Symblepharon

Introduction

Symblepharon is a challenging ocular surface condition involving the bulbar and palpebral conjunctiva, which occurs due to partial or complete adhesions between these structures [1]. This condition may arise from external factors such as chemical or thermal burns or endogenous factors like Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid (OCP), and severe dry eye disease. The entire ocular surface can be affected, leading to various complications, including restricted ocular motility, lagophthalmos, entropion, ptosis, and secondary detrimental effects on the cornea, which may impair vision [2].

Symblepharon is difficult to treat due to its high recurrence rate. Patients with advanced clinical stages of the disease often experience a high rate of therapeutic failure [3]. However, in cases caused by systemic diseases, systemic immunosuppressants can effectively control the condition [4]. Conversely, traumatic causes of symblepharon often require surgical intervention. Over time, the surgical approach has evolved from initial symblepharon lysis to defect covering with various techniques and additional measures. To address the defect, tissues such as the amniotic membrane, oral and nasal mucosa, conjunctival grafts, and split-thickness skin graft have been used [5]. In addition to surgery, non-surgical treatments like mitomycin C (MMC), artificial tears, and symblepharon rings are available. Despite the numerous surgical approaches, there is no consensus on the most effective method for achieving the best long-term results.

The development of new therapeutic approaches requires a better understanding of the molecular mechanisms behind the symblepharon formation. Although the exact pathophysiology remains unclear, several stages in its development have been identified, including conjunctival inflammation, tissue remodeling, and fibrosis. New treatment methods take these various stages into consideration and are currently being developed. These strategies include anti-adhesion therapies or treatments based on animal models to prevent or resolve symblepharon during these phases. Each stage involves distinct cellular and biological processes, which are essential to tailor effective therapeutic interventions [11].

Publication History

Received: 21 October 2024

Accepted: 17 December 2024

Article published online:
07 February 2025

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