Ocular Reconstruction After Diffuse Symblepharon Excision Secondary To Chemical Injury

Case report of diffuse symblepharon in the right eye following a chemical injury, with involvement of the visual axis and limitation of ocular movement, highlighting the technique of autologous conjunctival transplantation, which resulted in improved visual acuity and reduced complications.

This study was conducted at Hospital de Olhos CRO, in Guarulhos, São Paulo, Brazil. The patient directly sought care at the Cornea Department after previously consulting other ophthalmologists, who opted against a surgical approach. The patient was followed up through outpatient consultations and ultimately underwent surgery at the same hospital.

The patient is a 29-year-old male with a complaint of decreased visual acuity in the right eye following a chemical burn sustained at work five years ago. The visual acuity in the right eye without correction was finger counting at 1 meter, and in the left eye, 20/25. Biomicroscopy revealed symblepharon with adhesion at the temporal corner of the lower eyelid and diffusely on the cornea, involving the visual axis. There was also restriction of ocular movements, particularly in left gaze and upward gaze. Ultrasonic biomicroscopy (UBM) showed anterior corneal adhesion without cornal thinning. The patient underwent surgical correction of the symblepharon with autologous conjunctival transplantation.

The patient progressed without complaints, even after using a symblepharon lens for 3 months. There was no restriction of ocular motility, the fornix was formed with no adhesions, and there was diffuse anterior and middle stromal opacity with a visual acuity of 20/400. The patient attends weekly follow-ups with tapering of topical corticosteroids. Finally, the patient is still under ophthalmological care for a future surgical intervention to improve visual rehabilitation.

Symblepharon surgery with conjunctival fornix reconstruction is complex due to the risk of complications. The ideal approach is to use amniotic membrane; however, in its absence, conjunctival transplantation was performed, resulting in rapid corneal reepithelialization and improvement in vision, in accordance with the results reported in the literature.