Title : Ocular mucous membrane pemphigoid on a 59-year old male: A case report
Abstract:
Mucous membrane pemphigoid (MMP) is a systemic cicatrizing autoimmune disease that primarily affects orifical mucous membranes, such as the conjunctiva, the nasal cavity, the oropharynx, and the genitalia. Ocular MMP (OcMMP) occurs when the conjunctiva is the primary site of inflammation leading to chronic cicatrizing conjunctivitis. Ocular involvement occurs in about 70% of all MMP cases. This case report shows the course of a 59-year-old male, Filipino with recurrent cicatricial entropion with a history of multiple eyelid surgeries of bilateral entropion repair, bilateral tarsal fracture, and Botulinum toxin injections. The patient also had a history of corneal perforation secondary to central microbial keratitis. A conjunctival biopsy with direct immunofluorescence was done and a homogenous linear deposition of immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), and C3 in the conjunctival basement membrane zone was present confirming the diagnosis of OcMMP. The patient was treated with immunosuppressants in the form of Methotrexate and oral steroids. Supportive management with preservative-free lubricants, prophylactic antibiotic eye drops, and cyclosporine 0.05%. Management OcMMP is directed towards symptomatic relief of ocular surface pathology and stopping the underlying autoimmune process. Topical medications are given to address the ocular surface pathology, and systemic immunosuppressants are the main therapeutic strategy for OcMMP. Methotrexate is an effective treatment in moderate to severe OcMMP. Surgical interventions can be contemplated once adequate control of inflammation is achieved. In conclusion, Ocular mucous membrane pemphigoid is an autoimmune disease primarily affecting the conjunctiva that may lead to vision loss. A high index of suspicion in patients with cicatricial conjunctivitis, forniceal shortening, and symblepharon is vital. Early detection and prompt treatment are essential to halt disease progression.
