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First Author: V.Ho UK
Co Author(s): M. Watts
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To describe a case of ocular cicatricial pemphigoid (OCP) in a 68-year-old man who presented with a painful red eye.
Arrowe Park Hospital, Eye department, Wirral, United Kingdom
We report a case of a 68-year-old man who presented to the eye casualty with a week history of a left painful red eye associated with photophobia and dry mouth. Initial visual acuity was 6/6 in the right and 6/18 in the left. Anterior segment examination of the left eye showed trichiasis in the upper lid, an injected conjunctiva, fornix foreshortening, and a small peripheral corneal epithelial defect. Due to the site of corneal defect, marginal keratitis was diagnosed and patient was treated with topical antibiotic and steroid. Over the next 4 weeks, his visual acuity and symptoms continued to deteriorate. On repeat examination, his left eye visual acuity was 6/36 with a lower lid symblepharon and worsening of corneal epithelial defect measured 2x5mm. Examination of the right eye and both fundi were normal. To prevent further corneal ulceration, a lateral tarsorrhaphy was performed and a buccal mucosal membrane biopsy was taken. The diagnosis of OCP was made based on both clinical features and histopathology findings.
Patient was started on dapsone systemically. His symptoms and corneal epithelium continued to improve.
Ocular cicatricial pemphigoid is a rare but chronic, progressive potentially blinding condition. Differential diagnosis should include other causes of cicatricial conjunctivitis such as allergic conditions, infectious membranous conjuncitivits, systemic disease, drug-induced, trauma, radiation, chemical burns or malignancy. If OCP is suspected, a buccal mucosa biopsy can be obtained in first instance as it is less invasive and can prevent further trauma to the conjunctiva, leading to exacerbation of the disease process. Careful examination and early recognition are keys to visual preservation.