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THE EYES AND EB
Ms Gillian SIM  Ophthalmic Nurse Specialist
Mr Malcolm Kerr-Muir  Consultant Ophthalmologist

Lids and Conjunctival problems

Like the cornea, the lids and the conjunctiva are susceptible to blistering. The eyelids can form blisters at any time, but usually it happens as a result of rubbing the eyes, especially in children. Blisters are best treated in the same way as other areas of the body, but again dressings are a problem. Instillation of lubricants, especially if the blistering is at the lid margin is recommended, since distortion of the lid edges can cause disruption of the tearfilm, drying of the eye and resultant friction, possibly causing corneal or conjunctival blistering also.

Conjunctival blisters are treated in the same way as corneal erosions, although they tend not to be as painful, and photophobia is less.

Unfortunately, recurrent conjunctival and lid blistering can result in scarring, especially in the Dystrophic EB patients.

This can result in Symblephron, where the inside of the lid fuses to the conjunctiva. This causes problems with closure of the eyes and the tear film is disrupted since the surface of the eye becomes irregular.

If the eyelids become scarred as a result of recurrent blistering, incomplete closure, and inefficient blinking increase the incidence of corneal erosions. Lagophthalmos (inability of the lids to close properly) results in nocturnal exposure (eyelids remain open during sleep) which again causes drying of the eyes and possible blistering. Exposure of as little as 1-2mm appears to have an effect. It is often the parents or partner that become aware of the problem first since the patient is asleep and unaware.

Again, it appears that routine application of lubricants at night reduces the incidence of erosions of the cornea and conjunctiva. If the scarring and resultant distortion of the lids is severe, corrective surgery can be performed. This is best discussed with an ophthalmic/plastic surgeon experienced in the treatment of EB patients.

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