ADHESION OF THE EYELID TO THE BULB. SYMBLEPHARON.
Causes: Conjunctivitis, burns, operation and other wounds. In front of or behind the reflection of the mucosa from eye to lid. Prevention. Treatment: section of adhesion, and vaseline, etc., Two edges of healthy mucosa sutured together over the sore. When fornix is implicated mucosa is transplanted.
This is liable to occur to a greater or less extent, in all animals, in connection with violent conjunctivitis, burns and operation and other wounds. It has been divided into anterior and posterior symblepharon, the former being an union in front of the normal reflection of the conjunctiva from the lid upon the bulb (fornix), and the latter involving the fornix in the substance of the adhesion. The anterior form by anchoring the lid to the eyeball is much more likely to induce blindness, but it has the compensation that the union may be broken up and the parts healed without subsequent reunion. In the posterior form the eye can be better exposed and vision retained, its repair is much more difficult demanding transplantation of skin or mucous membrane on to the sore, and even then the granulation tissue being continuous from bulb to eyelid may so contract in healing as to leave matters no better than before.
These adhesions not only restrict the movements of the lids, preventing their opening and the exposure of the bulb, but they also anchor the bulb itself, and hamper its movements, necessitated for vision. In all cases therefore of wounds, burns, abrasions and ulcers, of the palpebral and bulbar mucosæ it is highly important to take precautions against the formation of such connections. Any forming adhesions must be broken up day by day and the surfaces must be kept apart in the intervals by borated or iodoformed vaseline.
In a small anterior symblepharon the connections may be cut through and subsequent adhesion prevented by the frequent introduction of iodoformed vaseline, and if need be, by the daily separation of the surfaces by a probe. When this fails a plastic operation may be resorted to, the mucosa on the inner side of the lid being incised in a vertical direction a short distance on each side of the sore and the inner edges accurately stitched together. The raw surface left on the bulb thus comes in contact only with the healthy mucous strips on the eyelid, which have been drawn together over the seat of the former sore, and the two new raw surfaces formed on the lid are well to each side of the sore on the bulb, and are in contact with its healthy mucosa only. Thus no two raw surfaces can come in contact, and adhesion is obviated.
When the fornix is implicated mucous membrane from the mouth, vulva, the bronchia of the rabbit, or the skin of the frog must be transplanted after the requisite incision of the cicatrix has been made.