Synechiae: Symptoms, Types, Causes and Treatment

Synechiae are abnormal adhesions or bands of tissue that form between anatomical surfaces that are normally separate. They can develop in various parts of the body, including the eyes, uterus, oral cavity, and genitalia, often leading to a range of clinical symptoms and complications. Understanding synechiae is crucial for early detection and effective management, especially as they can impact quality of life, fertility, and organ function.

Symptoms of Synechiae

Synechiae can be silent or cause a wide spectrum of symptoms depending on their location, severity, and underlying cause. Recognizing the signs is key to seeking timely medical intervention and avoiding long-term complications. Below is a summary of common symptoms associated with synechiae in different parts of the body.

Location	Key Symptom(s)	Impact	Source(s)
Uterus	Amenorrhea, infertility, hypomenorrhea	Menstrual changes, fertility issues	2, 4, 6
Eye	Visual disturbances, angle closure	Vision loss, glaucoma	3, 8
Genitalia	Labial fusion, urinary symptoms	Discomfort, UTIs	5, 9
Oral cavity	Restricted movement, feeding issues	Speech, feeding problems	1

Table 1: Key Symptoms

Uterine Synechiae

Uterine synechiae, also known as intrauterine adhesions or Asherman’s syndrome, often present with:

• Secondary amenorrhea (absence of menstruation after previous cycles)
• Hypomenorrhea (scanty or light periods)
• Infertility or repeated miscarriages
• Menstrual insufficiency (irregular or reduced menstrual flow)

In severe cases, the uterine cavity may be almost completely obliterated, which can cause total amenorrhea and prevent conception or successful pregnancy 2, 4, 6.

Ocular Synechiae

In the eye, synechiae can affect the iris:

• Posterior synechiae (adhesion of iris to the lens) may lead to irregular pupil shape and impaired vision
• Peripheral anterior synechiae (adhesion of iris to the cornea or trabecular meshwork) can cause angle closure, increasing intraocular pressure and risk of glaucoma 3, 8

Symptoms include:

• Blurred vision
• Eye pain or discomfort
• Possible visual field loss in advanced cases

Genital and Vaginal Synechiae

In females, particularly young girls and women post-childbirth, synechiae can result in:

• Labial fusion (labia minora stuck together)
• Altered appearance of the external genitalia
• Difficulty with urination, urinary tract infections (UTIs), or discomfort 5, 9

Oral Synechiae

Congenital oral synechiae may present as:

• Restricted tongue or jaw movement
• Feeding difficulties in infants
• Possible impact on speech development 1

Types of Synechiae

Synechiae are categorized based on their anatomical location, clinical presentation, and underlying cause. Understanding these distinctions is essential for accurate diagnosis and tailored treatment.

Type/Location	Description	Clinical Relevance	Source(s)
Uterine/Intrauterine	Adhesions within uterine cavity	Infertility, amenorrhea	2, 4, 6, 7, 11
Ocular	Iris-lens or iris-cornea adhesions	Glaucoma, visual loss	3, 8, 10
Genital/Vaginal	Labial or vaginal wall fusion	UTIs, discomfort	5, 9
Oral	Membranes between oral structures	Speech, feeding issues	1

Table 2: Types of Synechiae

Uterine (Intrauterine) Synechiae

• Definition: Bands of scar tissue forming within the uterus, often after trauma, infection, or surgical intervention.
• Clinical Classification: Severity can range from mild filmy adhesions to dense bands obliterating the uterine cavity 2, 4, 6, 7, 11.
• Special Cases: Total corporal synechiae (entire uterine cavity involved), particularly difficult to treat if caused by tuberculosis 2.

Ocular Synechiae

• Posterior Synechiae: Adhesions between the iris and lens, commonly due to inflammation or trauma 8, 10.
• Peripheral Anterior Synechiae: Adhesions between the iris and cornea, often seen in angle-closure glaucoma or with structural abnormalities (e.g., iridociliary cysts) 3.
• Classification: Graded by the extent of iris involvement or number of clock hours affected 8.

Genital and Vaginal Synechiae

• Labial Synechiae: Fusion of the labia minora, mostly in prepubertal girls or postpartum women. Can be complete or partial 5, 9.
• Vaginal Synechiae: Adhesions within the vaginal canal, less common but can cause significant discomfort and complications.

Oral Synechiae

• Congenital Types:
  • Persistence of buccopharyngeal membrane
  • Ectopic membranes (subglossopalatal, glossopalatal ankylosis, syngnathia)
• Clinical Impact: Feeding, speech, and sometimes associated limb anomalies 1.

Causes of Synechiae

The formation of synechiae is multifactorial, resulting from a mix of trauma, infection, inflammation, congenital defects, and hormonal factors. Identifying the cause is crucial for prognosis and prevention.

Cause	Mechanism/Trigger	Typical Location	Source(s)
Trauma/Surgery	Curettage, postpartum interventions	Uterus, vagina	4, 6, 7
Infection	Tuberculosis, inflammation	Uterus, eye	2, 4, 11
Congenital	Abnormal embryologic fusion	Oral cavity	1
Hormonal	Hypoestrogenism (children, postpartum)	Genitalia	5, 9
Inflammation	Uveitis, chronic irritation	Eye, genitalia	3, 8, 10

Table 3: Common Causes of Synechiae

Trauma and Surgical Procedures

• Uterine Synechiae: Most often result from trauma to the uterine lining, especially after curettage following miscarriage, delivery, or abortion 4, 6, 7.
• Procedures like bimanual uterine massage or repeated manual uterine examination increase the risk after postpartum hemorrhage 6.
• Vaginal/Genital: Trauma (e.g., during delivery or from injury) can trigger adhesions 5.

Infection

• Tuberculosis: Particularly aggressive cause of dense, recurrent uterine synechiae with poor prognosis for fertility restoration 2.
• Other Infections: Chronic endometritis, sexually transmitted infections, or other inflammatory conditions may contribute 4, 11.

Congenital Factors

• Oral synechiae may develop due to abnormal persistence or formation of embryonic membranes, leading to fusion of oral structures or even limb anomalies 1.

Hormonal Factors

• Hypoestrogenism: Low estrogen levels in prepubertal girls or postpartum women can predispose to labial synechiae 5, 9.

Inflammatory and Immune Factors

• Ocular Synechiae: Result from chronic inflammation (e.g., uveitis), surgery, or trauma, leading to abnormal adhesion formation between the iris and adjacent structures 3, 8, 10.

Treatment of Synechiae

Treatment of synechiae aims to restore normal anatomy and function, alleviate symptoms, and prevent recurrence. Approaches vary by location, cause, and severity.

Location	Treatment Method(s)	Goal/Outcome	Source(s)
Uterus	Hysteroscopic lysis, resectoscopy, laminaria, IUD insertion, estrogen therapy	Restore cavity, menstruation, fertility	2, 7, 11
Eye	Mydriatic agents, iridectomy, synechiolysis	Prevent vision loss, maintain pupil mobility	8, 10
Genitalia	Manual separation, topical antibiotics, steroid creams	Release adhesions, prevent recurrence	5, 9
Oral cavity	Surgical incision/removal	Restore function	1

Table 4: Treatment Approaches

Uterine Synechiae

• Hysteroscopic Lysis: Gold standard for intrauterine adhesions; involves breaking down scar tissue under direct visualization 7, 11.
• Transcervical Resectoscopy: Especially effective in severe cases; laminaria tents may be used to dilate and prepare the cavity 7.
• Adjuncts: Insertion of intrauterine devices (IUDs), estrogen therapy, and antibiotics post-procedure to prevent recurrence and promote healing 7.
• Poor Prognosis in TB: Uterine synechiae from tuberculosis are highly recurrent and challenging to treat; surrogacy may be necessary for fertility 2.

Ocular Synechiae

• Mydriatic Agents: Used postoperatively to prevent formation of posterior synechiae by keeping the pupil mobile 8.
• Microperipheral Iridectomy: A surgical technique to separate troublesome synechiae, especially useful in pediatric or complex cases 10.
• Synechiolysis: Mechanical separation using surgical instruments as needed 10.

Genital and Vaginal Synechiae

• Manual Separation: Performed in clinic, especially for labial synechiae in children; followed by topical antibiotics and attention to hygiene 9.
• Topical Steroids: May be prescribed to promote healing and prevent recurrence, particularly in thicker or recurrent cases 5.
• Surgical Incision: Required for severe or persistent cases 5.

Oral Synechiae

• Surgical Release: Incision or excision of the membrane or band to restore oral function; approach depends on type and severity 1.

Conclusion

Synechiae are complex, multifaceted adhesions that can form in various body regions, leading to significant clinical consequences if left untreated. Prompt recognition and evidence-based management are key to restoring function and quality of life.

Key Takeaways:

• Synechiae symptoms are highly location-dependent, ranging from menstrual changes and infertility to vision loss, discomfort, and feeding issues.
• Types of synechiae include uterine, ocular, genital/vaginal, and oral, each with distinct clinical implications.
• Causes are diverse: trauma, infection (notably tuberculosis in the uterus), congenital defects, hormonal imbalances, and chronic inflammation.
• Treatment is tailored to location and severity, with hysteroscopic lysis and estrogen therapy for uterine cases, mydriatic agents and iridectomy for ocular involvement, manual separation for genital adhesions, and surgical release for oral synechiae.
• Early diagnosis and intervention are crucial for optimal outcomes and prevention of long-term complications.

By understanding the underlying mechanisms and current treatment strategies, healthcare providers can better support patients affected by synechiae in any form.