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.