2 English reference symbols
3. Summarize the symblepharon, that is, the adhesion state between eyelid, bulbar conjunctiva and cornea.
Symblepharon mostly occurs in chemical (acid or alkali) burns, thermal burns, explosive injuries, conjunctival diseases such as Stevens-Johnson syndrome, conjunctival pemphigus, severe trachoma, conjunctival surgery and other sequelae. Severe symblepharon can limit eyeball movement and diplopia, and can also form entropion, trichiasis and canthus deformity. According to the adhesion range, it can be divided into partial, extensive, complete symblepharon and closed symblepharon.
Due to the contraction of conjunctival scar, the vault is shortened or even completely disappeared, especially in the lower part of the vault. When the eyelid is pulled down, vertical folds can be seen in the conjunctiva between the eyelid and eyeball. Patients with severe symblepharon have limited eyeball rotation in all directions, often accompanied by different degrees of corneal static lesions, such as corneal leukoplakia, and even eyeball atrophy.
The treatment of closed symblepharon should consider the patient's age, eye condition and general condition, comprehensively analyze the advantages and disadvantages, treat them differently, and adopt different surgical methods according to the degree of symblepharon.
It is difficult to repair severe symblepharon and improve the appearance. The cornea and intraocular tissue are seriously damaged, and the recovery of visual function is hopeless. Pay attention to labor protection and operation safety.
4 disease name symblepharon
5 English name symblepharon
6 Classification Ophthalmology > Eyelid Diseases
7 ICD number H02.8
Epidemiology symblepharon is directly related to ocular chemical injury, and there is no clinical epidemiological data related to it at present.
Chemical conjunctival trauma is an ophthalmic emergency, accounting for about 10% of ocular trauma. Among the eye injuries caused by chemicals, 65,438+07% were caused by solid chemicals, 365,438+0% by liquid chemicals and 52% by chemical smog. Among the eye injuries caused by these chemicals, they can be caused by direct contact with the eyes, or they can affect the eyes, visual paths or visual centers through systemic absorption through the skin, respiratory tract and digestive tract.
9 causes of symblepharon symblepharon mostly occurs in chemical (acid, alkali) burns, thermal burns, explosive injuries, conjunctival diseases such as Stevens-Johnson syndrome, conjunctival pemphigus, severe trachoma and conjunctival surgery. Severe symblepharon can limit eyeball movement and diplopia, and can also form entropion, trichiasis and canthus deformity. According to the adhesion range, it can be divided into partial, extensive, complete symblepharon and closed symblepharon.
The pathogenesis of 10 conjunctival chemical injury is mostly acid-base burn, and its pathological process is generally divided into four stages: ① degeneration and necrosis stage; ② Inflammatory reaction period; ③ Ulcer hyperplasia stage; ④ Scar period.
Acidic substances can cause protein's degeneration and form a barrier after solidification, so the damage can be confined to superficial tissues. Alkaline chemical burns are more serious. Alkaline substances can cause lipid saponification of corneal epithelium, and combine with mucin and collagen in corneal stroma, thus destroying the barrier of corneal conjunctiva and infiltrating into tissues, which can rapidly increase the pH value in anterior chamber, cause damage to lens and anterior uvea, and even lead to eyeball atrophy in severe cases. Alkali burn is often a complicated and long pathological process, which can be divided into three stages with reference to Hughes' staging method and relevant domestic data.
10. 1 sec to ~24h hours after acute burn. Generally, alkaline substances can penetrate the cornea and enter the anterior chamber within a few minutes after injury. It is characterized by corneal and conjunctival epithelial necrosis and shedding, conjunctival edema and ischemia, corneal stroma edema and turbidity, extensive thrombosis and bleeding in corneal limbus and nearby blood vessels. There may even be acute iriditis, and even a large amount of flocculent exudation in the anterior chamber. The cornea of patients with severe alkali burn is porcelain white, and no intraocular tissue can be seen. Due to the ischemic necrosis of iris and ciliary body, the secretion of aqueous humor decreased and the intraocular pressure decreased significantly.
During the repair period of 10.2, corneal epithelium began to regenerate from 5 to 7 days to 2 weeks after injury, new blood vessels gradually invaded the cornea, and iritis tended to be static.
Complication stage 10.3 enters the complication stage 2 ~ 3 weeks after burn, and there are often repeated and persistent aseptic corneal ulcers, which lead to corneal perforation every time. After the necrotic tissue of eyelid conjunctiva falls off, scar healing, dome shortening or disappearance, eyelid adhesion or corneal leukoplakia and thick pannus, and even eyelid atresia occur, which develops into dry eyeball, uveitis, cataract, glaucoma or eyeball atrophy.
Clinical manifestations of symblepharon 1 1 Due to the contraction of conjunctival scar, the fornix is shortened or even completely disappeared, especially in the lower part of the fornix. When the eyelid is pulled down, vertical folds can be seen in the conjunctiva between the eyelid and eyeball. Patients with severe symblepharon have limited eyeball rotation in all directions, often accompanied by different degrees of corneal static lesions, such as corneal leukoplakia, and even eyeball atrophy.
The complications of 12 symblepharon may be complicated with cataract, uveitis, secondary glaucoma and corneal leukoplakia.
13 laboratory examination and pathological examination: the materials were from the excised scar tissue. The general pathological manifestations of symblepharon are irregular epithelial hyperplasia, angiogenesis and connective tissue hyperplasia, and obvious scar formation.
14 auxiliary inspection There is no special auxiliary inspection.
The diagnosis of 15 symblepharon is easy to diagnose according to the history of ocular trauma and clinical manifestations of the eye.
16 Treatment of symblepharon 16. 1 Treatment of closed symblepharon The treatment of closed symblepharon should consider the patient's age, eye condition and general condition, comprehensively analyze the advantages and disadvantages, and treat them differently.
16.1.1(1) Older people suffer from symblepharon, and plastic surgery is generally not the first consideration. We must first know whether the heart, blood vessels and the whole body can endure plastic surgery simply to improve their appearance for a long time.
16. 1.2 (2) Young patients with unilateral closed ptosis, although the recovery of visual function is hopeless, in order to improve their appearance, they must meet the requirements of patients. The purpose of total conjunctival sac reconstruction is to put the artificial eye piece into it, so as to achieve the goal of symmetrical eyeball appearance and all-round movement, and to confuse the false with the real. In view of the difficulty of this operation, it is difficult to ensure the success of autologous lip mucosa transplantation at one time, because the lip mucosa is particularly easy to break during suture, which leads to the failure of the operation. However, if the total conjunctival sac is reconstructed by autologous thin-section skin graft, one operation will be successful.
16. 1.3 (3) Young patients with bilateral closed ptosis Young patients with bilateral closed ptosis, as long as they still have light perception, no matter whether the positioning of light perception is accurate or not, the materials for total conjunctival sac reconstruction must use autologous lip mucosa to create conditions for the slightest light.
16. 1.4 (4) Severe burns often lead to symblepharon. Severe burns often lead to allergic reactions in patients with symblepharon. If anyone is allergic to drugs or food, it is not appropriate to do any surgery for symblepharon at this time, although the burn time has passed 1 year. Otherwise, the operation will not only fail, but also aggravate the lesion. It is necessary to check stool eggs. If they are positive, they should be dewormed and desensitized by calcium supplementation. With the passage of time, the allergic phenomenon of the body gradually subsided before operation.
16.2 According to the different degrees of symblepharon, different surgical methods were adopted, and the analysis is as follows:
16.2. 1 (1) partial symblepharon partial symblepharon caused by strap scar can be eliminated by "z" plastic surgery. If it is fan-shaped adhesion, try to restore the fornix and eyelid conjunctiva and repair the bulbar conjunctiva defect.
16.2.2 (2) Extensive symblepharon. Extensive symblepharon mostly occurs in severe burns (chemical and molten metal), which often completely burns the conjunctiva of the eyelid, resulting in the loss of the vault, and the adhesion between the eyelid and cornea is large, often accompanied by eyelid edge and partial eyelid defects. Correct the symblepharon first, and then deepen the fornix. In most cases, lip mucosa transplantation is needed, and the eyelid margin and eyelid defect should be corrected as appropriate after the symblepharon disappears.
16.2.3 (3) symblepharon refers to the complete adhesion of the upper eyelid or the lower eyelid to the eyeball, and the eyelid margin is often completely lost, or even partially defective. However, some conjunctival sac remains, which is the sequela of severe burns (Figure 1).
After severe burn, the whole eyelid is adhered, and there is no tarsal plate and orbicularis oculi muscle in front of the tarsal plate. Therefore, for the scar connective tissue stripped from the eyeball, we can only make multiple cuts perpendicular to the scar direction to loosen the scar, but we can't completely remove it, and keep them as substitutes for the tarsal plate, otherwise all the scars will be removed, leaving only a thin layer of scar skin, without tarsal plate, tarsal margin and orbicularis oculi muscle, and the transplantation of lip mucosa will definitely fail.
16.2.4 (4) Eyelid atresia, molten metal, pure acid, concentrated alkali and other extremely serious sequelae of eye burns. Destroy the integrity of the eyeball, become a grape swelling or eyeball atrophy. At the same time, the palpebral margin and conjunctival sac disappeared, the tarsal plate melted, and the eyelids also had different degrees of defects, so that the upper and lower eyelids were completely locked and adhered to the eyeball. In this case, most visual functions have been lost (Figure 2). This situation does not require surgery.
17 symblepharon with severe prognosis is difficult to repair and improve its appearance. The cornea and intraocular tissue are seriously damaged, and the recovery of visual function is hopeless.
Prevention of symblepharon 18 Pay attention to labor protection and operation safety.
19 related drug collagen
Acupoint geomantic omen for treating symblepharon