Which disease is most commonly associated with symblepharon?

• A. Orbital pseudotumor
• B. Trachoma
• C. Dacryocystitis
• D. Ocular cicatricial pemphigoid

Answer: (D)

Symblepharon forms when the conjunctiva scars and the palpebral and bulbar surfaces stick together. This kind of scarring is a hallmark of cicatrizing conjunctival diseases. Ocular cicatricial pemphigoid is a mucous membrane autoimmune condition that relentlessly scars the conjunctiva, often leading to symblepharon, fornix foreshortening, and eyelid changes. Because of its tendency to cause progressive conjunctival fibrosis, it is the classic association with symblepharon. Trachoma can also scar the conjunctiva and produce adhesions in advanced disease, but ocular cicatricial pemphigoid is the prototypical cause clinicians look for when symblepharon is present. Orbital pseudotumor and dacryocystitis do not typically cause this conjunctival adhesion pattern.