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Vesiculobullous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Snejina Vassileva, Kossara Drenovska
Clinical presentation: MMP may affect any mucous membrane lined by Malpighian epithelium. The average age of onset is 65 years, but it can occur in children and young adults. The most common sites of involvement are the oral and ocular mucosa, where blisters and erosions may heal with scarring and cause significant disability. The ocular disease can progressively lead to symblepharon, entropion, trichiasis, and blindness (Figure 14.7a). Other sites include the pharynx, nose, larynx, esophagus, anus, and genitals, where the scarring process and adhesions can lead to stenosis, strictures, and atresia.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Treatment: prevention is the best approach in conditions where symblepharon may be acquired; topical lubrication and steroids may be needed but ophthalmic opinion must be sought early. Once formed amniotic membrane may be used to treat after resection of the symblepharon.
Mucous membrane pemphigoid
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Dipankar De, Sheetanshu Kumar, Sanjeev Handa
Patients with conjunctival involvement initially present with unilateral disease and mild, nonspecific symptoms, such as burning, dryness, and foreign-body sensation (Figure 11.1) [27]. Later the disease may progress to involve both eyes in a period of about 2 years [28]. Gradually, fibrosis, conjunctival scarring, forniceal shortening, and symblepharon occur, later progressing to ankyloblepharon. Up to 20% of MMP patients have disease limited to conjunctiva, called ocular pemphigoid [27].
Simultaneous presentation of orbital mantle cell lymphoma and endocrine mucin-producing sweat gland carcinoma
Published in Orbit, 2022
Darsh S. Shah, Natalie A. Homer, Aliza Epstein, Vikram D. Durairaj
A 77-year old man with no previous cancer history presented with painless progressive left globe proptosis noticed over the preceding 1 month. He additionally described an enlarging left upper lid margin lesion present for the past 1 year (Figure 1). He reported left-sided tearing, and denied vision changes, diplopia, discomfort, and constitutional symptoms. On examination, he had a non-tender palpable superior orbital mass extending across the superior orbit, with resistance to retropulsion. Symblepharon was noted spanning from the superior and inferior palpebral conjunctiva to the nasal bulbar conjunctiva. He was also observed to have a flesh-colored, domed lesion on the medial left upper eyelid margin without madarosis or ulceration. Clinical evaluation revealed visual acuity 20/30 on the right and 20/70 on the left, with a left relative afferent pupillary defect and 6 mm relative left globe proptosis measured via a Hertel exophthalmometer. Dilated ophthalmic examination was unremarkable.
Characteristics of work-related eye trauma in construction and manufacturing industries
Published in Clinical and Experimental Optometry, 2022
Cagri Ilhan, Mehmet Citirik, Mehmet M Uzel, Selim Bagli
Symblepharon which was the most prevalent finding of eyelid, occurred in three subjects (2.2%) in the construction group and six (7.3%) in the manufacturing group. Corneal scar was the most common anterior segment finding, occurring in 85 subjects (61.6%) in the construction group and 56 (68.3%) in the manufacturing group. The most prevalent posterior segment finding was retinal detachment, which occurred in 45 subjects (32.6%) in the construction group and 19 (23.2%) in the manufacturing group. Retinal detachment occurred significantly more often in the construction group (p = 0.042). There was no significant difference between groups in terms of other clinical findings of eyelid, anterior segment, and posterior segment (p > 0.05 for all). The details of the clinical findings were demonstrated in Figure 3.
Reliability of Conjunctival Biopsy for Diagnosis of Ocular Mucous Membrane Pemphigoid: Redetermination of the Standard for Diagnosis and Outcomes of Previously Biopsy-Negative Patients
Published in Ocular Immunology and Inflammation, 2021
Stephen D. Anesi, Laura Eggenschwiler, Mariantonia Ferrara, Pichaporn Artornsombudh, Marisa Walsh, C. Stephen Foster
Among 136 patients, 108 (79%) were diagnosed with oMMP on the basis of positive biopsy. Among the 28 patients who were biopsy-negative, oMMP was still highly suspected in 5 patients on the basis of clinical picture; all patients were affected by a progressive cicatrizing chronic conjunctivitis refractory to topical therapies with abnormal tear film, conjunctival inflammation, papillary reaction with subepithelial fibrosis and fornix foreshortening. Symblepharon was present in 3 and corneal neovascularization in 2 of them. All the other possible causes of the above-mentioned signs had been excluded, such as atopic disease, lid laxity or lagophthalmos, meibomian gland dysfunction (MGD), other systemic autoimmune diseases. The diagnoses in the remaining 23 patients were the following: atopic keratoconjunctivitis (12 patients), ocular rosacea with meibomian gland dysfunction (4 patients), sarcoidosis (3 patients), superior limbic keratoconjunctivitis (2 patients) and isolated conjunctival lichen planus (2 patients). The 23 patients with negative biopsy were treated, on the basis of their final diagnosis, with artificial or serum tears, topical steroids or cyclosporine. Doxycycline was administered orally in all patients with ocular rosacea with meibomian gland dysfunction. All three patients with sarcoidosis were treated also with brief courses of corticosteroids orally.