Symblepharon

Types of symblepharon
Causes of symblepharon
Symptoms
Diagnostic tests
Non-pharmacological treatments (therapies and other measures)
Drug treatments
Dietary molecular supplements
Immune/regen/stem-cell”–type therapies
Surgeries
Prevention tips
When to see a doctor
What to eat and what to avoid
Frequently asked questions (FAQ)

Symblepharon means the inner skin of the eyelid sticks to the white surface of the eye. The inner skin of the eyelid is called the palpebral conjunctiva. The white surface of the eye is covered by the bulbar conjunctiva. Both are thin, moist membranes. They should slide smoothly over each other every time you blink. In symblepharon, scar tissue grows between these two surfaces. This scar acts like a bridge. It pulls the eyelid and the eyeball together. The normal eyelid pocket (the fornix) becomes short or even closed. Blinking becomes rough. Tears do not spread well. The eye surface dries out and becomes inflamed. Over time, the scar can pull the eyelid, change its shape, and limit eye movement. The eye may feel tight, sore, dry, and sensitive to light. Vision can blur from dryness, scarring, or surface damage.

Symblepharon is a scar-like band that sticks the pink inner surface of the eyelid (the palpebral conjunctiva) to the white of the eye (the bulbar conjunctiva) or to the cornea. In a healthy eye, these two smooth, moist surfaces slide freely when you blink and look around. When the eye suffers strong inflammation, chemical or thermal burns, severe allergies, autoimmune disease (especially ocular cicatricial pemphigoid), infections (for example after trachoma), or surgical trauma, the healing response can lay down sticky fibrin and then firm collagen between the two surfaces. This “bridge” of tissue is the symblepharon. It may look like a thin string, a broad sheet, or a deep attachment that shortens the cul-de-sac behind the eyelid (the fornix).

Symblepharon is not the same as ankyloblepharon. Ankyloblepharon is when the eyelid edges stick to each other. In symblepharon, the sticking is between the eyelid lining and the eyeball surface. Symblepharon is also different from a pterygium. A pterygium is a wing-shaped growth from the white part over the cornea. Symblepharon is a scar bridge, not a wing growth.

The key idea is simple: injury or inflammation of the conjunctiva causes healing by scarring. Scars contract. Contracting scars pull tissues together. When the two raw surfaces touch during healing, they fuse. The result is a permanent adhesion. This is symblepharon.

Types of symblepharon

By how much of the eyelid pocket is involved (extent):
- Partial symblepharon: Only a small bridge of scar binds the eyelid lining to the eyeball. The fornix is still open in most places. Symptoms are milder but can still be irritating.
- Subtotal symblepharon: A large part of the fornix is scarred and shortened. Blinking and eye movement are clearly affected. Dryness and irritation are more severe.
- Total symblepharon: The fornix is almost or completely closed by scar. The eyelid cannot move freely over the eye. Dry eye and surface damage are major problems. Vision may suffer.
By location around the clock (where it sits):
- Superior (upper) symblepharon: Involves the upper eyelid pocket. It can restrict upward gaze and make the upper lid feel tight.
- Inferior (lower) symblepharon: Involves the lower eyelid pocket. It often causes a low tear lake and marked dryness.
- Medial or lateral symblepharon: Involves the inner or outer corners. It may affect tear drainage at the inner corner or cause side-gaze discomfort at the outer corner.
By depth of the pocket (fornix status):
- Mild fornix shortening: The pocket is shallow but present.
- Moderate shortening: The pocket is clearly reduced, and a cotton tip cannot pass easily.
- Severe shortening / obliteration: The pocket is nearly or completely gone.
By cause (what started it):
- Chemical or thermal injury-related symblepharon: Follows acid, alkali, or heat injuries. Alkali burns are especially damaging.
- Autoimmune scarring conjunctivitis-related: From diseases like ocular mucous membrane pemphigoid (also called ocular cicatricial pemphigoid), Stevens–Johnson syndrome / toxic epidermal necrolysis, linear IgA disease, or epidermolysis bullosa acquisita.
- Infection-related: Follows severe conjunctival infections like trachoma or membrane-forming viral conjunctivitis.
- Trauma- or surgery-related: After eyelid or conjunctival surgery, pterygium surgery, cryotherapy, radiotherapy, or penetrating injuries.
- Chronic inflammation-related: From long-standing allergic or atopic eye disease, severe dry eye, or chronic topical medication toxicity.
By stability (how the disease behaves):
- Inactive (burned-out) symblepharon: Scars are mature and quiet. The main problem is mechanical stickiness and dryness.
- Active inflammatory symblepharon: The surface is still inflamed. Redness, pain, and new scar bands can appear and progress.

Causes of symblepharon

Alkali chemical burns (e.g., lye): Alkali penetrates deeply and destroys conjunctival cells and supporting tissue. Healing by scarring glues the eyelid lining to the eye.
Acid chemical burns: Acid usually causes surface coagulation but still can scar. When the raw surfaces touch during healing, adhesion forms.
Thermal burns (heat or fire): Heat damages the conjunctiva like a skin burn. The raw, wet surfaces heal together and fuse.
Ocular mucous membrane pemphigoid (MMP/OCP): This autoimmune disease attacks the basement membrane where the conjunctiva anchors. Repeated inflammation leads to scarring and adhesions.
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN): Severe drug or infection-triggered reactions cause widespread mucous membrane damage. The eyelid lining and eye surface stick as they heal.
Trachoma (chronic Chlamydia trachomatis infection): Long-term infection scars the conjunctiva. Scars pull and tether the eyelid lining to the eye.
Severe membrane-forming viral conjunctivitis (e.g., adenoviral): Pseudomembranes or true membranes peel and leave raw areas that can scar and adhere.
Eyelid or conjunctival trauma (cuts, lacerations, penetrating injuries): Wounds heal by scar. If the two surfaces are in contact, a bridge forms.
Surgery on the conjunctiva (e.g., pterygium surgery) or repeated procedures: Any surgery that leaves raw conjunctiva can create adhesions if not protected.
Cryotherapy or radiotherapy to the conjunctiva: These treatments can kill tissue and lead to scarring bridges.
Severe atopic keratoconjunctivitis: Chronic allergic inflammation thickens and scars the conjunctiva. Rubbing also worsens damage.
Chronic topical medication toxicity (e.g., preservatives like benzalkonium chloride over years): Constant chemical irritation inflames and scars the surface.
Severe dry eye disease (keratoconjunctivitis sicca): Without tears, the surface breaks down and heals with scarring, making adhesions more likely.
Autoimmune blistering diseases (linear IgA disease, epidermolysis bullosa acquisita): Fragile mucous membranes blister and scar, joining eyelid lining to eye.
Ocular graft-versus-host disease (after bone marrow transplant): Immune attack on mucous membranes scars the conjunctiva.
Severe trachomatous scarring with trichiasis: Inward-turning lashes scratch the surface, causing recurrent injury and scarring adhesions.
Severe chemical exposure at work (industrial accidents): Repeated or heavy exposure damages conjunctiva and leads to symblepharon.
Thermal cautery to eyelid or conjunctiva (procedural complications): Heat used to stop bleeding can accidentally scar and tether tissues.
Severe burns of facial skin and eyelids with contracture: Tight, scarred lids press the raw inner lining against the eye during healing.
Congenital symblepharon (rare): Some babies are born with lid-eye adhesions due to developmental anomalies or in-utero injury.

Symptoms

Feeling of tightness or pulling: The eyelid feels tethered to the eyeball, especially when trying to look up, down, or sideways.
Foreign-body sensation: It feels like sand or grit in the eye because the scar bridge scratches during blinking.
Dryness and burning: The fornix is shortened, so the tear reservoir is small. Tears do not spread well, causing burning dryness.
Redness and irritation: Constant friction from the scar keeps the eye red and irritated.
Light sensitivity (photophobia): The dry and inflamed surface makes bright light uncomfortable.
Watering or tearing: The eye may water from irritation, but the tears do not coat the eye well, so it still feels dry.
Mucous discharge or stringy secretions: Inflamed surfaces produce thick mucus that sticks to the scar band.
Blurred vision: Dry spots and surface damage scatter light. Scarring can also change corneal shape.
Pain or aching: Raw or inflamed areas and tight scars cause soreness that worsens with blinking.
Trouble moving the eye fully: The adhesion acts like a leash. Side gaze or up-gaze may feel limited or painful.
Difficulty wearing contact lenses: The shortened pocket and rough surface make lenses intolerable.
Eyelid shape changes (entropion, ectropion) or misdirected lashes (trichiasis): Scars pull the lid margin. Lashes can rub the eye.
Recurrent surface erosions: The top layer of the eye surface can peel off, causing sudden sharp pain and tearing.
Poor night comfort and sleep disturbance: Night dryness and irritation wake the person or make sleep difficult.
Cosmetic concerns and reduced confidence: Visible scarring, redness, and lid changes can affect appearance and mood.

Diagnostic tests

Note: Symblepharon is mainly a clinical diagnosis. Most cases are identified by careful eye examination with the eyelids gently everted. Extra tests help measure severity, find the cause, plan treatment, and rule out related problems. Below are practical tests grouped into Physical Exam, Manual Tests, Lab/Pathology, Electrodiagnostic (rarely needed), and Imaging.

A) Physical exam tests

Visual acuity testing (distance and near):
You read letters on a chart. This shows how much your vision is affected. Blurry vision can come from dryness, scarring, or irregular cornea. Tracking vision over time helps judge if the condition is stable or getting worse.
External inspection and lid position assessment:
The doctor looks at the eyelids, corners, and skin. They check for entropion (lid turns in), ectropion (lid turns out), and trichiasis (lashes rubbing). They note redness and crusting. This tells how much the lid anatomy has changed because of scarring.
Slit-lamp biomicroscopy with eyelid eversion:
A microscope with bright light shows details. The doctor gently flips the upper and lower lids and looks at the fornix depth. They look for bands of scar that bridge to the eye surface. They inspect the conjunctiva and cornea for dryness, erosions, or ulcers.
Ocular surface staining and tear film breakup time (TBUT):
Dyes like fluorescein, lissamine green, or rose bengal are placed in the tears. Under blue or white light, dry spots and damaged cells stain. TBUT measures how fast tears break into dry patches. Short TBUT means poor tear stability from a shortened fornix and inflamed surface.
Schirmer test or phenol red thread test:
Small paper strips or threads measure tear production. In symblepharon, tear quantity may be normal or low, but distribution is almost always poor. These tests provide a baseline for dryness.

B) Manual tests

Fornix depth measurement with a cotton-tipped applicator or fornix gauge:
The clinician gently inserts a moistened cotton tip into the fornix to estimate depth. A special ruler can also be used. A shallow or obliterated fornix confirms mechanical shortening and helps grade severity.
Gentle sweeping of the fornix with a glass rod or cotton tip (mapping adhesions):
The doctor runs a smooth rod along the fornix to feel and see where the eye and lid are stuck. This maps the length, thickness, and location of the scar bands.
Forced duction test (to check mechanical restriction):
After numbing drops, the doctor uses forceps or a cotton tip to gently move the eye while you relax the muscles. If movement is blocked, the problem is mechanical (scar tether) rather than a nerve issue. This matters for planning surgery.
Eyelid laxity tests (snap-back and distraction):
The lid is pulled and released to see if it returns quickly and fits the eye well. Scarring can make the lid stiff or malpositioned, which worsens dryness and friction.

C) Lab and pathological tests

Conjunctival biopsy for routine histology (H&E):
A tiny piece of conjunctiva is removed, usually from an inflamed area away from the scar band. Under the microscope, the pathologist looks for scarring patterns and inflammation. This can suggest an autoimmune cause.
Conjunctival biopsy for direct immunofluorescence (DIF):
This special stain looks for immune proteins along the basement membrane. A positive linear pattern supports ocular mucous membrane pemphigoid or related blistering diseases. This test guides the need for systemic immune-modulating treatment.
Serologic tests (indirect immunofluorescence / ELISA for BP180, BP230, type VII collagen, and related antibodies):
A blood test looks for antibodies linked to blistering disorders. Not all patients are positive, but a positive result supports the diagnosis and helps the care team choose therapy.
Microbiologic testing (culture or PCR) when infection is suspected:
Swabs from the conjunctiva may be tested for Chlamydia trachomatis (trachoma), herpes viruses, or bacteria/fungi. Treating an infection reduces inflammation and prevents new scarring.
Tear film tests (osmolarity and MMP-9 point-of-care):
Small samples of tears can be tested for saltiness (osmolarity) and for an enzyme called MMP-9 that rises in surface inflammation. High values support dry-eye-type inflammation associated with symblepharon.

D) Electrodiagnostic tests (rare, used only when needed)

Blink reflex study (trigeminal–facial reflex) using surface electrodes:
If eyelid closure seems weak or delayed, a neurologist can test the nerve circuit that closes the eyelids. This rules out nerve problems when the lid does not protect the eye well.
Orbicularis oculi electromyography (EMG):
This measures the electrical activity of the eyelid closing muscle. It is rarely needed, but it helps if there is uncertainty about muscle weakness versus mechanical restriction.
Visual evoked potential (VEP):
If vision loss looks worse than expected from surface disease, VEP checks the pathway from the eye to the brain. A normal VEP with poor surface points back to ocular surface damage as the main cause.

These electrical tests are not routine for symblepharon. They serve special cases where the doctor suspects nerve or muscle problems on top of mechanical scarring.

E) Imaging tests

Anterior segment optical coherence tomography (AS-OCT):
This is a light-based scan that shows cross-sections of the conjunctiva and cornea. It can outline scar bands, measure fornix depth, and show where the lid lining is fused to the eye. It helps plan surgery and follow healing.
Ultrasound biomicroscopy (UBM):
UBM uses high-frequency ultrasound to image the front of the eye and the conjunctival layers. It helps when the surface is too scarred to see through or when deeper structures need assessment.
Infrared meibography (meibomian gland imaging):
Chronic scarring and inflammation often damage the oil glands in the eyelids. Meibography shows gland dropout or distortion. Poor oil production worsens dryness, so this imaging guides lid care and lubrication strategies.

Non-pharmacological treatments (therapies and other measures)

Each item explains what it is (Description), why we use it (Purpose), and how it helps (Mechanism). These items do not rely on drug effects; they are devices, techniques, habits, or procedures performed without medicines.

Education and trigger control
Description: Calm, practical coaching about the disease, expected course, and risky triggers (chemical splashes, eye rubbing, dusty or windy air).
Purpose: Reduce future damage and flares.
Mechanism: Removing the provoking factor lowers inflammation peaks that drive scarring.
Environmental humidification
Description: Use room humidifiers and avoid strong air conditioning or fans blowing to the face.
Purpose: Keep the ocular surface moist.
Mechanism: More ambient moisture reduces evaporation, friction, and micro-trauma that encourage adhesions.
Blink training and screen hygiene
Description: 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds) and full, gentle blinks.
Purpose: Improve tear distribution and surface lubrication.
Mechanism: Regular blinking refreshes the tear film and keeps the two conjunctival surfaces from sticking.
Warm compress and lid hygiene
Description: Clean lids and lashes with diluted baby shampoo or lid wipes after warm compresses.
Purpose: Treat blepharitis and meibomian gland dysfunction that worsen dryness.
Mechanism: Better oil layer → slower tear evaporation → less friction and microulcers → lower scarring stimulus.
Cold compress in acute irritation
Description: Short, clean cold packs on closed lids.
Purpose: Soothe burning and swelling after a flare.
Mechanism: Vasoconstriction and reduced nerve firing lower itch–rub cycles and inflammatory exudate.
Sterile saline or balanced salt rinses
Description: Non-medicated, preservative-free rinsing of the eye as advised.
Purpose: Gently clear mucus, debris, and inflammatory mediators.
Mechanism: Mechanical washing reduces sticky material that can act as a “glue.”
Bandage soft contact lens (BSCL)
Description: A thin, soft lens fitted by an eye-care professional.
Purpose: Protect the corneal surface and decrease pain during epithelial healing.
Mechanism: Physical shield reduces friction and micro-trauma; smoother healing lowers the chance of adhesion.
Scleral lens / PROSE device
Description: A large rigid lens that vaults over the cornea and holds a pool of sterile fluid.
Purpose: Continuous liquid bandage for severe dryness or irregular surfaces.
Mechanism: The fluid reservoir keeps tissues separated and hydrated, countering scar-driven sticking.
Symblepharon ring / fornix conformer
Description: A smooth ring or custom plastic conformer placed inside the fornix.
Purpose: Keep the eyelid and eye surfaces physically apart during healing.
Mechanism: Continuous separation of raw surfaces prevents bridges from forming.
Gentle mechanical sweeping (office procedure)
Description: An eye doctor uses a lubricated glass rod or cotton applicator to gently break fresh, thin adhesions.
Purpose: Release early bands before they mature.
Mechanism: Mechanical lysis interrupts collagen bridging while tissues are still pliable.
Moisture chamber goggles
Description: Wraparound, sealed eyewear for daytime or sleep.
Purpose: Trap humidity around the eyes and block wind.
Mechanism: A stable, humid micro-environment reduces evaporation and friction.
Nighttime eyelid taping / sleep shields
Description: Gentle nighttime taping or use of a sleep mask when lids do not close fully.
Purpose: Prevent exposure-related dryness.
Mechanism: Maintains lid–globe coverage so the surfaces do not dry and stick.
Protective eyewear and face shields at work
Description: ANSI-rated splash goggles and shields in labs, factories, and kitchens.
Purpose: Prevent chemical burns—the biggest preventable cause.
Mechanism: Physical barrier blocks alkali/acid contact that triggers aggressive scarring.
Eyelash epilation (non-drug)
Description: Removal of misdirected lashes by a clinician.
Purpose: Stop constant lid–cornea rubbing.
Mechanism: Less rubbing → less inflammation → less stimulus for scar adhesion.
Nutritional and hydration habits (behavioral)
Description: Scheduled water intake; whole foods rich in vitamins A, C, and omega-3s (details below).
Purpose: Support epithelial healing and tear quality.
Mechanism: Adequate nutrients provide building blocks and antioxidants for surface repair.
Low-vision aids when scarring affects vision
Description: High-contrast lighting, magnifiers, and large-print tools.
Purpose: Keep reading and daily tasks safe while treatment proceeds.
Mechanism: Compensates for reduced clarity and field.
Punctal occlusion (device-based)
Description: Tiny plugs placed in tear drainage openings (no systemic drug effect).
Purpose: Keep natural tears on the eye longer.
Mechanism: Conserves tears, increases lubrication, and reduces mechanical stickiness.
Early amniotic membrane device (e.g., ring-mounted) in the acute phase
Description: A single-use biologic membrane on a ring, placed like a contact lens.
Purpose: Speed epithelial recovery after severe surface injury.
Mechanism: Provides a basement-membrane-like scaffold and anti-inflammatory signals that limit scarring.
Debridement of early fibrin membranes (office-based)
Description: Careful removal of loose fibrin sheets under topical anesthesia.
Purpose: Prevent fibrin from maturing into fixed scar bands.
Mechanism: Eliminates the “template” on which collagen could anchor.
Psychological support and habit coaching
Description: Stress management, itch-scratch cycle counseling, adherence tools.
Purpose: Improve consistency with protective behaviors.
Mechanism: Better adherence reduces flare frequency and scar progression.

Drug treatments

Doses here are typical examples—always individualized by an eye specialist. Many require monitoring and are not self-medications.

Preservative-free lubricants (drops/gel/ointment)
Class: Ocular lubricants.
Dosage & time: Drops 4–8×/day or more; gel/ointment at bedtime and as needed.
Purpose: Reduce friction, protect healing epithelium.
Mechanism: Thickens the tear film and physically separates surfaces.
Side effects: Temporary blur; very rare irritation if sensitive to components.
Topical corticosteroids (e.g., prednisolone acetate 1%, loteprednol 0.5%)
Class: Anti-inflammatory steroid.
Dosage & time: From every 2–4 hours during acute flares, then slow taper; exact plan by clinician.
Purpose: Quell active inflammation that drives scarring.
Mechanism: Blocks multiple inflammatory pathways and fibroblast activation.
Side effects: Elevated eye pressure, cataract risk with long use, infection risk—needs medical supervision.
Topical cyclosporine A (0.05–0.1%)
Class: Calcineurin inhibitor (immunomodulator).
Dosage & time: Usually twice daily; benefits build over weeks.
Purpose: Long-term control of surface inflammation and dryness.
Mechanism: Reduces T-cell–mediated inflammation and improves goblet cell function.
Side effects: Burning on instillation, rare allergy.
Topical tacrolimus (0.03–0.1% ointment or solution, off-label ocular use)
Class: Calcineurin inhibitor.
Dosage & time: Nightly to twice daily to eyelid margins/conjunctiva under supervision.
Purpose: Steroid-sparing control in allergic/cicatrizing disease.
Mechanism: Potent T-cell suppression reduces scarring signals.
Side effects: Stinging, rare local irritation; systemic absorption is minimal in ocular use.
Topical antibiotic prophylaxis (e.g., moxifloxacin 0.5%) when epithelium is open
Class: Fluoroquinolone antibiotic.
Dosage & time: Typically 3–4×/day for a short course during epithelial defects.
Purpose: Prevent secondary infection while the surface heals.
Mechanism: Bactericidal action against common ocular pathogens.
Side effects: Mild stinging; rare allergy.
Oral doxycycline (50–100 mg twice daily)
Class: Tetracycline antibiotic with anti-collagenase effect.
Dosage & time: Weeks to months as directed.
Purpose: Reduce meibomian inflammation and matrix metalloproteinase (MMP) activity.
Mechanism: Inhibits MMPs and decreases inflammatory cytokines → less tissue melt and scarring.
Side effects: Sun sensitivity, stomach upset; avoid in pregnancy/children.
Systemic corticosteroids (e.g., prednisone)
Class: Anti-inflammatory steroid.
Dosage & time: Short courses for flares in severe autoimmune causes (e.g., ocular cicatricial pemphigoid—OCP).
Purpose: Rapid control of dangerous inflammation.
Mechanism: Broad suppression of inflammatory gene expression.
Side effects: Glucose rise, mood changes, infection risk, bone loss—requires careful taper and monitoring.
Dapsone
Class: Anti-inflammatory sulfone (first-line for mild OCP in many protocols).
Dosage & time: Often 50–100 mg/day after checking G6PD status.
Purpose: Long-term control of autoimmune scarring.
Mechanism: Inhibits neutrophil-mediated tissue damage.
Side effects: Hemolysis in G6PD deficiency, anemia, methemoglobinemia—needs lab monitoring.
Mycophenolate mofetil (MMF)
Class: Antimetabolite immunosuppressant.
Dosage & time: Commonly 1–1.5 g twice daily as a steroid-sparing agent.
Purpose: Control OCP or other severe immune causes.
Mechanism: Blocks lymphocyte purine synthesis → reduced autoimmune attack.
Side effects: GI upset, leukopenia, teratogenicity—regular labs required.
Rituximab ± intravenous immunoglobulin (IVIG) for refractory OCP
Class: Anti-CD20 monoclonal antibody (B-cell depleter); IVIG is pooled antibodies.
Dosage & time: Specialist protocols (e.g., 375 mg/m² weekly ×4 or 1 g on days 1 and 15).
Purpose: Control scarring when standard agents fail.
Mechanism: Depletes B cells and dampens autoantibody-driven inflammation.
Side effects: Infusion reactions, infection risk; given by experienced teams.

Other agents sometimes used by specialists include azathioprine or cyclophosphamide for severe, progressive cases—always with close monitoring.

Dietary molecular supplements

Supplements can support general ocular surface health but do not replace medical care. Discuss with your clinician, especially if you take anticoagulants, are pregnant, or have chronic disease.

Omega-3 fatty acids (EPA/DHA)
Dosage: 1,000–2,000 mg/day combined EPA+DHA.
Function & mechanism: Anti-inflammatory eicosanoid balance; may improve meibomian oil quality and tear stability.
Vitamin C (ascorbic acid)
Dosage: 500 mg twice daily (adjust for kidney health).
Function & mechanism: Collagen co-factor and antioxidant; supports orderly wound healing.
Vitamin A (or beta-carotene as a safer precursor)
Dosage: Beta-carotene 3,000–6,000 µg/day; avoid high-dose preformed vitamin A unless prescribed.
Function & mechanism: Essential for mucosal epithelium and goblet cells.
Vitamin D3
Dosage: 1,000–2,000 IU/day (personalize to blood levels).
Function & mechanism: Immune modulation and epithelial health.
Zinc
Dosage: 8–11 mg elemental zinc/day (do not exceed 40 mg/day chronically).
Function & mechanism: Enzyme co-factor in epithelial repair and antioxidant defense.
N-acetylcysteine (NAC)
Dosage: 600 mg once or twice daily.
Function & mechanism: Antioxidant and mucolytic; reduces mucus strings and oxidative stress.
Gamma-linolenic acid (GLA)
Dosage: 240–300 mg/day (from borage or evening primrose oil).
Function & mechanism: Converts to anti-inflammatory prostaglandins that may help dry eye symptoms.
Curcumin (turmeric extract with enhanced absorption)
Dosage: 500–1,000 mg/day of standardized extract.
Function & mechanism: NF-κB pathway down-regulation; systemic anti-inflammatory support.
Selenium
Dosage: 100–200 µg/day (watch total intake).
Function & mechanism: Antioxidant enzyme (glutathione peroxidase) co-factor aiding cellular protection.
Quercetin
Dosage: 500 mg/day.
Function & mechanism: Flavonoid with mast-cell stabilizing and antioxidant properties—may help itch–rub cycles.

Immune/regen/stem-cell”–type therapies

People often say “hard immunity booster” or “stem cell drugs.” In eye care, we do not boost the immune system indiscriminately because that can worsen scarring. Instead, we either normalize immune activity or use regenerative biologics that support healing. Some are medications; others are prepared biologic drops. All require specialist oversight.

Autologous serum eye drops (ASED)
Dosage: Commonly 20–50% serum in sterile saline, 4–8×/day.
Function: Delivers natural growth factors (EGF, NGF), vitamins, and albumin from your own blood.
Mechanism: Mimics the biology of tears, supports epithelial migration and nerve health.
Platelet-rich plasma (PRP) or platelet lysate eye drops
Dosage: Protocols vary (often 4–8×/day).
Function: Higher levels of platelet-derived growth factors.
Mechanism: Stimulates epithelial repair and may limit scar-prone healing.
Umbilical cord serum eye drops (allogeneic, specialized centers)
Dosage: Center-specific.
Function: Rich growth-factor profile when autologous serum is not feasible.
Mechanism: Similar to ASED/PRP; used under strict screening and protocols.
Cenegermin (recombinant human nerve growth factor) 20 µg/mL
Dosage: 1 drop 6×/day for 8 weeks (approved for neurotrophic keratitis).
Function: For eyes with nerve damage and poor corneal healing.
Mechanism: Promotes corneal nerve regeneration and epithelial healing; may be helpful if NK co-exists with symblepharon-related surface damage.
Rebamipide 2% eye drops (region-specific availability, e.g., Japan)
Dosage: Typically 4×/day.
Function: Mucin secretagogue for ocular surface disease.
Mechanism: Increases mucin production, stabilizes tear film, and supports epithelial health.
Lifitegrast 5% eye drops
Dosage: Twice daily.
Function: Immunomodulator for inflammatory dry eye.
Mechanism: Blocks LFA-1/ICAM-1 interaction, reducing T-cell–driven surface inflammation that can feed scar formation.

Note: Limbal stem cell transplantation (SLET/CLET/KLAL) is a surgical cell-based therapy (covered below), not a “drug,” but it is the true stem-cell solution when limbal stem cell deficiency contributes to scarring.

Surgeries

Surgical symblepharon lysis with amniotic membrane transplantation (AMT)
Procedure: Under the microscope, the surgeon carefully dissects the scar bands, frees the eyelid from the globe, and sutures or glues an amniotic membrane over raw areas; a conformer or ring keeps the fornix deep.
Why: Remove the bridge and immediately re-surface wounds with a biologic scaffold to prevent re-adhesion.
Fornix reconstruction with buccal (oral) mucous membrane graft
Procedure: A thin graft is harvested from the inner cheek or lip and sewn into the fornix after lysis.
Why: Rebuild depth and a smooth, non-keratinized lining when conjunctiva is scarce.
Limbal stem cell transplantation (SLET/CLET/KLAL)
Procedure: Limbal tissue from the same eye, the fellow eye, or a cadaver donor is transplanted as small explants (SLET) or cultivated on a carrier (CLET); keratolimbal allograft (KLAL) uses larger donor segments.
Why: Restore the stem-cell niche that maintains a healthy, non-scar-prone surface and reduces recurrence risk.
Pterygium excision with conjunctival autograft ± mitomycin-C
Procedure: For symblepharon linked to pterygium, the growth is removed, scar tissue is freed, and a conjunctival graft is secured; a carefully dosed anti-fibrotic (MMC) may be applied.
Why: Eliminate the source of traction and re-cover the bare sclera to lower recurrence.
Temporary tarsorrhaphy and anchoring sutures with conformer
Procedure: Partial eyelid closure and anchoring sutures may be placed after reconstruction; a custom conformer or ring is left in place for weeks.
Why: Protect the surface during the vulnerable healing window and maintain fornix depth.

Prevention tips

Use certified splash goggles when handling chemicals at work or home.
Treat eye allergies early and avoid rubbing; ask about immunomodulating drops when needed.
Prefer preservative-free eye drops when using them often.
Keep lids clean and oil glands healthy to support the tear film.
Build a high-humidity, low-wind environment for long screen sessions.
Act quickly after any burn: copious irrigation, then emergency eye care.
Follow post-operative eye instructions exactly to avoid inflammatory flares.
Stop smoking; it delays epithelial healing.
Maintain good general nutrition and hydration.
Keep a symptom diary (irritants, activities) so your care team can adjust protection.

When to see a doctor

New string or sheet of tissue connecting eyelid to eyeball, or pulling sensation when looking around.
Increasing redness, pain, light sensitivity, or discharge.
Trouble opening the eye fully, double vision, or restricted eye movements.
Recurrent erosions, non-healing “raw” spots, or frequent mucus strings.
Immediately after any chemical or thermal eye injury—even if it seems mild.
Signs suggesting ocular cicatricial pemphigoid (oral/genital mucosal sores, scarring, or chronic red eyes) or a history of Stevens–Johnson syndrome.
If you wear contact lenses and they suddenly become uncomfortable or impossible to insert.
After eye surgery if there is unexpected pulling or tightness.

Early care prevents a small, soft adhesion from becoming a deep, stiff scar.

What to eat and what to avoid

What to eat more of:

Fatty fish (sardine, salmon, mackerel) 2–3 times/week for omega-3s that calm inflammation.
Colorful fruits and vegetables (carrot, spinach, kale, bell pepper, citrus, berries) for vitamins A and C to support mucosal healing.
Nuts and seeds (walnut, chia, flaxseed) for additional omega-3s and minerals.
Whole grains and legumes for steady energy and micronutrients that help cellular repair.
Lean proteins (eggs, poultry, tofu) to provide amino acids for tissue rebuilding.
Fermented foods (yogurt, kefir) for broad immune balance.
Plenty of water across the day to support tear volume.

What to limit or avoid:

Tobacco smoke and vaping—they slow healing.
Ultra-processed snacks high in trans fats and added sugars—promote inflammation.
Excess alcohol, which dehydrates and disturbs sleep and tear quality.
Mega-doses of vitamin A without a doctor’s plan—risk of toxicity.
Personal food allergens that worsen atopy and eye rubbing (track with a diary).

Frequently asked questions (FAQ)

1) Is symblepharon contagious?
No. It is a scar process, not an infection. Some infections or inflammatory diseases can trigger it, but the adhesion itself does not spread between people.

2) Can a small symblepharon go away by itself?
Fresh, very thin bands can sometimes be released by a clinician in the office. Mature collagen bands do not melt away on their own and may need procedural or surgical release.

3) Will artificial tears cure it?
Lubricants do not dissolve scar tissue, but they reduce friction, improve comfort, and lower the chance of new adhesions forming.

4) When is surgery necessary?
When adhesions limit eye movement, keep recurring despite office care, shorten the fornix, or threaten the cornea or vision, surgical release with surface reconstruction is considered.

5) Can it come back after surgery?
Yes, recurrence is possible, especially when the cause (e.g., OCP) is still active. Surgeons use amniotic membrane, grafts, conformers, and careful post-op plans to reduce this risk, and your medical team treats the underlying inflammation.

6) Are steroid eye drops dangerous?
They are powerful tools when used correctly. Long use can raise eye pressure and speed cataract formation. That’s why they are prescribed with a plan, monitoring, and often a steroid-sparing partner like cyclosporine or tacrolimus.

7) What is ocular cicatricial pemphigoid (OCP) and why does it matter?
OCP is an autoimmune disease that scars mucous membranes, including the eye. It is a leading cause of recurrent symblepharon. It requires systemic therapy under specialists to protect sight.

8) Can I wear contact lenses if I have symblepharon?
Standard soft lenses may be uncomfortable or impossible. A scleral lens/PROSE device can be very helpful because it vaults over the cornea and bathes it in fluid.

9) Is there any role for “stem cell” treatment?
Yes—limbal stem cell transplantation is a surgical option when the corneal stem-cell niche is damaged. It restores a healthier ocular surface and can reduce recurrence, but it is reserved for selected cases.

10) Do diet and supplements really matter?
They can support healing and comfort but cannot replace medical and surgical care. Think of them as good soil for better regrowth.

11) How long is recovery after surgery?
Initial healing is usually weeks; full remodeling takes months. Conformers or rings may stay in for several weeks to keep the fornix deep while tissues mature.

12) What if I had a chemical burn?
Immediate, copious irrigation is lifesaving for the eye surface, followed by urgent specialist care. Early use of amniotic membrane and careful anti-inflammatory therapy can prevent severe scarring.

13) Can children get symblepharon?
Yes, after burns, infections, or congenital conditions. Pediatric care emphasizes protection, lubrication, and early reconstruction to prevent amblyopia and long-term restriction.

14) Will glasses help?
Glasses protect from wind and debris and improve vision if refractive error is present. Wraparound designs also reduce evaporation and discomfort.

15) What are the biggest mistakes to avoid?
Ignoring early signs, rubbing the eyes, stopping prescribed medicines abruptly, and using heavily preserved drops many times per day without advice.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 27, 2025.

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