Ocular cicatricial pemphigoid
 

Ocular cicatricial pemphigoid showing loss of caruncle,  shallowing of the lower fornix and symblepharon. Shallowing of the lower fornix and symblepharon in ocular cicatricial pemphigoid

. There are symblepharons (seen mainly inferiorly) with shortening of the lower fornix. The tear film is poor. The caruncles are obliterated (this may be the first sign in early ocular cicatricial pemphigoid). The eyelids may be distorted giving rise to entropion, ectropion and trichiasis. The cornea may be opacified with neovascularization. Look for: ulcers on the tongue or buccal mucosa skin lesions

Questions:

1. What conditions may simulate ocular cicatricial pemphigoid?

Answer
chemical burnt
Steven-Johnson's syndrome
conjunctival malignancies

2. How would you treat a patient with ocular cicatricial pemphigoid?

Answer
ocular lubricant with artificial tears and ointments
topical steroid for acute inflammation
severe cases may need systemic steroid and immunosuppressants such as dapsone or cyclophosphamide
oculoplastic surgery for trichiasis and entropion to reduce further damage to the cornea.

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