Ocular cicatricial pemphigoid (Review)

Branisteanu,Daniel   Constantin; Stoleriu,Gabriela; Branisteanu,Daciana   Elena; Boda,Daniel; Branisteanu,Catalina   Ioana; Maranduca,Minela   Aida; Moraru,Andreea; Stanca,Horia   Tudor; Zemba,Mihail; Balta,Florian

doi:10.3892/etm.2020.8972

Ocular cicatricial pemphigoid (Review)

Authors:
- Daniel Constantin Branisteanu
- Gabriela Stoleriu
- Daciana Elena Branisteanu
- Daniel Boda
- Catalina Ioana Branisteanu
- Minela Aida Maranduca
- Andreea Moraru
- Horia Tudor Stanca
- Mihail Zemba
- Florian Balta
View Affiliations

Affiliations: Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania, Clinical Department, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800008 Galați, Romania, Department of Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania, Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania, Department of Physiology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania, Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
Published online on: July 7, 2020 https://doi.org/10.3892/etm.2020.8972
Pages: 3379-3382
Copyright: © Branisteanu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Ocular cicatricial pemphigoid is a particular form of mucous membrane pemphigoid and it is characterized by a chronic bilateral conjunctivitis with relapsing‑remitting periods. Without therapy 75% of the cases develop visual loss due to major ocular complications (e.g. severe dry‑eye syndrome, corneal erosions, corneal keratinization, entropion, symblepharon). Pathogenesis remains uncertain and probably linked to an autoimmune type II hypersensitivity response in patients with a genetic predisposition and exposure to different environmental triggers. With a worldwide distribution, no racial predilection and an estimated incidence that largely varies from 1/10,000‑1/60,000, ocular cicatricial pemphigoid predominantly affects women aged ~60 years. Conjunctival biopsy with direct immunofluorescence is the gold standard in diagnosis confirmation, but up to 40% of the patients have a negative biopsy result that does not rule out the diagnosis. The skin and many other mucous membranes (e.g. oral, trachea, esophagus, pharynx, larynx, urethra, vagina and anus) may be involved. The disease grading relies on Foster staging system (based on clinical signs) and Mondino and Brown system (based on the inferior fornix depth loss). The differential diagnosis includes atopy, allergies, trauma, chemical burns, radiation, neoplasia, infectious, inflammatory and autoimmune etiologies. The main goals of the treatment are to stop disease progression, to relieve symptoms and to prevent complications. With long‑term systemic therapy 90% of the cases can be efficiently controlled. While Dapsone is the first‑line treatment in mild to moderate disease in patients without G6PD deficiency, more severe cases require immunosuppressant therapy with azathioprine, mycophenolate mofetil, methotrexate or cyclosporine. Cyclophosphamide, biologics (etanercept or rituximab) and intravenous immunoglobulin therapy are usually reserved for recalcitrant disease and unsatisfactory results to conventional therapy. Dry eye syndrome requires constant lubricating medication and topical steroids, cyclosporine‑A and tacrolimus. Surgery should be planed only in quiescent phase as minor conjunctival trauma can significantly worsen the disease.

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