Keratolimbal allograft may be used for ocular surface reconstruction in symblephara treatment

Symblepharon is adhesion of the eyelid palpebral conjunctiva to the bulbar conjunctiva. It may be partial or complete, affecting one or both eyelids, and can cause significant morbidity in affected individuals. Such an adhesion of subepithelial scarring can compromise not only the fornix, but also obliterate the fornix and potentially result in ankyloblepharon, especially if the inflammation is not effectively controlled in a timely fashion. Significant alteration or obliteration of the normally occurring fornix can compromise or eliminate the all-important tear reservoir, as pointed out by Tseng, and secondarily have an adverse effect on the tear meniscus. Without adequate tear spread with each blink, the ocular surface can potentially deteriorate to culminate in irreversible blindness. Hence, symptomatic symblepharon associated with active inflammation needs to be considered a clinically significant finding that requires appropriate management for optimizing outcomes and relieving associated ocular symptoms.The eyelid is an important and integral component of the mechanisms needed to keep the ocular surface healthy and the cornea transparent. Symblepharon can secondarily affect the eyelid in ways that can limit ocular motility and cause symptoms of diplopia, contribute to incomplete blink and altered tear spread, and result in an unstable tear film; this can lead to an unhealthy, deteriorating ocular surface that can progress to surface keratinization and corneal opacification. Thus, entropion, misdirected lashes, trichiasis, ptosis, lacrimal gland blockage and ankyloblepharon can all be the eyelid effects of uncontrolled, progressive symblepharon. Additionally, anatomic alterations in the fornix can cause difficulty with contact lens wear and interference with intraocular surgery.