What Is Synechiae?

  • Jialu Li Master of Science in Language Sciences (Neuroscience) UCL

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Living with unfamiliar health conditions can be very scary. If you or a loved one has recently been diagnosed with synechiae, you are likely to be in this position, with so many questions, or you may even be intimidated by the uncertainty or lack of familiarity with the condition. In this article, we will explain synechiae in an easy-to-understand way, so that you can get the information you need to make the best and the most well-informed decisions about your health.

Introduction

Definition of synechiae

“Synechiae” is a word that refers to abnormal bands of tissue that can form between two surfaces on the inside of the body that are normally separate, and connect them.1 They are also referred to as adhesions.3 This abnormal tissue fusion can limit the normal range of motion and also limit the function of the affected body part. Synechiae can occur in different parts of the body, including the nostril, penis, veins, vocal cords, and vulva.2 However, most commonly, it occurs in the eye or in the uterine cavity.2 While the specific properties of synechiae can vary due to their location on the body, synechiae share general causes, symptoms, diagnosis, and treatment approaches.

With proper attention, early detection and adequate medical care, synechiae can usually be managed effectively.

Significance of understanding synechiae

Although synechiae are not as commonly known as some other health conditions, getting a good understanding of synechiae is certainly important for those who are affected. Abnormal tissue bands that have the potential to restrict normal motion in the body can interfere with vital functions in the body. For example, synechiae in the eye can impair vision while synechiae in the uterus can result in infertility

Recognising early symptoms and promptly seeking medical advice is key to detecting synechiae soon after they first develop. This allows for earlier treatment intervention, which can minimise permanent damage and prevent long-term complications.

Accurate knowledge always empowers individuals to be proactive advocates for their own health.

Types of synechiae

As mentioned earlier, synechiae are not usually specific to any particular location in the body, but they can occur in a range of places around the body. Some of the most common types of synechiae, based on where in the body they occur are:

Ophthalmic Synechiae

Ophthalmic synechiae refers to abnormal tissue connecting parts of the eye. The two main types of ophthalmic synechiae are:

  • Anterior Synechiae: Adhesions between the iris and the cornea or lens. This limits iris movement and affects pupil shape.
  • Posterior Synechiae: Adhesions between the iris and the lens.2 This pulls the iris tissue, which can block fluid drainage in the eye.

Gynecological Synechiae

This refers to adhesions within the uterine cavity. Two conditions fall under this category:

  • Intrauterine Adhesions: Fibrous tissue connecting the walls of the uterus. This may or may not obstruct the uterine cavity.
  • Asherman's Syndrome: Formations of bands of scar tissue inside the uterine cavity, that obstructs the uterine cavity and can lead to partial or complete closure of the cavity.4

Causes and mechanism

While synechiae can arise from multiple causes, inflammation is the most common trigger.

Let’s look at factors that contribute to the formation of synechiae in the eye and uterus:

Ophthalmic Synechiae

For ophthalmic synechiae, contributing factors include:6

  • Uveitis: Swelling of the middle eye tissues like the iris.
  • Glaucoma: Increased eye pressure that damages the optic nerve.
  • Eye injury or trauma: Harm to eye structures, even from surgery.

Gynecological Synechiae

For gynaecological synechiae, contributing factors include:5

In both situations, when the affected body part gets hurt or is in an inflammatory state, sometimes it tries to heal itself, but it ends up causing nearby parts to stick together in a way that can cause more harm in the future. In the process of the body trying too hard to heal itself, it overcompensates and creates these tight and restrictive bands of adhesive tissues known as synechiae.

How synechiae might affect you?

Ophthalmic Synechiae

If you're dealing with ophthalmic synechiae, you might notice these signs:6

  • Your vision could become blurry, or you might have other strange visual problems
  • Your eyes might feel painful, itchy, or look red
  • Your eyes may be overly sensitive to light  

Gynecological Synechiae

For gynaecological synechiae, symptoms often involve:7

  • Your menstrual cycles may act strangely, leading to heavy bleeding, reduced volume or duration of bleeding, or even missed periods
  • Trying to have a baby might be challenging, as scar tissue can block the way for sperm and embryos

Should any of these concerns arise, it's essential to reach out to an eye specialist (ophthalmologist) or a women's health expert (gynaecologist). They can perform eye exams or uterine scans to figure out if synechiae are causing your troubles and what can be done to help you.

Diagnosis and detection

To diagnose ophthalmic synechiae, eye doctors use:

  • Slit lamp exam: Eye doctors may use something called a slit lamp exam, which allows them to take a really close look at the front of your eye
  • Gonioscopy: Another tool they can use is called gonioscopy, which helps them see what's happening with the eye's drainage system.

For gynaecological synechiae, diagnostic procedures include:

  • Hysteroscopy: A procedure known as hysteroscopy is used, where a tiny camera is introduced into your uterus to directly observe what's going on in there
  • Ultrasound: Involves using sound waves to create images of your uterus and its structures

Once these adhesions are identified, the focus shifts to gently restoring things back to how they should be, so you can feel better.

Treatment and management

There are effective options available to treat and manage synechiae. They range from surgical to non-surgical methods, with the goal of restoring normal function for the affected body part.

For the eyes, options include:6

  • Eye drops: For ophthalmic synechiae, eye doctors may first prescribe medicated eye drops to apply daily at home. Steroid eye drops work to reduce inflammation, while pupil-dilating drops can prevent the pupil from becoming distorted or blocked by synechiae tissue bands. With mild synechiae, these medications may be the only treatment needed.
  • Surgery: In more severe cases of abnormal eye tissue adhesion, surgery performed by an ophthalmologist may be recommended. During delicate eye surgery, the adhesions are carefully separated to open up structures like the pupil and drainage angle. Though the process can sound frightening, modern techniques make synechiae removal a less daunting procedure. With an experienced surgeon, there is minimal pain and quick recovery.

For the uterus, treatment methods involve:8

  • Hormonal therapy: Doctors may also recommend oestrogen supplements, which encourage healthy regrowth of the uterine lining after scar tissue is removed. This hormonal therapy helps prevent new adhesions from forming as the uterus heals.
  • Hysteroscopic adhesiolysis: Gynaecologists can remove problematic uterine scar tissue during a minimally invasive hysteroscopy procedure. Guided by a tiny camera, doctors use an instrument to precisely cut bands of synechiae adhesions. This helps open up the uterine cavity and restore its normal shape. Hysteroscopy requires only mild sedation, with patients able to go home the same day.

While synechiae treatment options vary depending on the location in the body, the good news is medical professionals have the tools and knowledge to help patients restore normal function. With a combination of skilful surgical techniques and medications when needed, quality of life can be significantly improved by eliminating restrictive adhesions.

Prognosis and recovery

Ophthalmic Prognosis

The prognosis for ophthalmic synechiae depends on the extent of abnormal tissue. Mild adhesions often respond well to medication. But more severe synechiae that are not discovered on time may lead to permanently impaired vision even after surgery9

Gynaecological Prognosis

For gynaecological synechiae, mild cases generally have good fertility outcomes after adhesiolysis. However, moderate to severe scarring can reoccur and negatively impact conception7

Importance of Follow-up Care

Continuing to monitor symptoms and undergo regular general exams, be it eye exams or uterine imaging is so important. This helps detect any new synechiae early before they worsen.

Summary

Recap of synechiae and their implications

In summary, synechiae are abnormal tissue adhesions between structures meant to be separate. Ophthalmic and gynaecological synechiae are some of the common types of synechiae that can significantly disrupt normal anatomy and functions in the body. However, modern medicine offers ways to diagnose synechiae through imaging tests and directly visualise the affected areas. With the right interventions, these abnormal tissue bands can be removed and related symptoms alleviated.

Emphasising the importance of timely diagnosis and appropriate treatment

The key is identifying synechiae early and beginning appropriate treatment as soon as possible. If you notice any vision changes, menstrual irregularities, or fertility difficulties, promptly consult medical professionals. They can determine if synechiae are present and help safeguard your ocular, uterine, and reproductive health over the long run.

Encouragement for seeking professional medical advice

You don’t have to live in fear of the unknown. Accurate information is powerful especially when faced with unfamiliar conditions like synechiae. Hopefully, this article has provided you with a helpful overview of this condition - its causes, detection, management, and outlook. With the right medical team supporting you, synechiae can be effectively treated so you can get back to living your best life.

References

  1. Medical definition of synechiae [Internet]. [cited 2023 Nov 1]. Available from: https://www.merriam-webster.com/medical/synechiae
  2. Luijkx T. Radiopaedia. [cited 2023 Nov 1]. Synechiae | radiology reference article | radiopaedia. Org. Available from: https://radiopaedia.org/articles/synechiae
  3. Nahirniak P, Tuma F. Adhesiolysis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563219/
  4. Dreisler E, Kjer JJ. Asherman’s syndrome: current perspectives on diagnosis and management. Int J Womens Health [Internet]. 2019 Mar 20 [cited 2023 Nov 1];11:191–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430995/
  5. Smikle C, Yarrarapu SNS, Khetarpal S. Asherman syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448088/
  6. Synechiae - eyewiki [Internet]. [cited 2023 Nov 1]. Available from: https://eyewiki.org/Synechiae
  7. Klein SM, García CR. Asherman’s syndrome: a critique and current review. Fertil Steril. 1973 Sep;24(9):722–35. Available from: https://www.sciencedirect.com/science/article/pii/S0015028216399186?via%3Dihub
  8. Thomson AJM, Abbott JA, Deans R, Kingston A, Vancaillie TG. The management of intrauterine synechiae. Curr Opin Obstet Gynecol. 2009 Aug;21(4):335–41.

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Babasola Olaoluwa David

MBBS Babcock, University, Nigeria
MPH, University Of York, UK

David is a seasoned and compassionate medical professional with several years of experience providing exemplary patient care. While earning his medical degree in Nigeria, he honed his skills
during internships in India. As a licensed physician in Nigeria, David has worked in leading hospitals and clinics in the country. In his pursuit for further knowledge, he gained a Master’s degree in Public Health from the University of York.

David is passionate about using his medical knowledge to equip people with the ability to boost the quality of their lives by taking control of their health.

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