Vesiculobullous Diseases
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in Roxburgh's Common Skin Diseases, 2022
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.
Mucous membrane pemphigoid
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
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].
How to master MCQs
Chung Nen Chua, Li Wern Voon, Siddhartha Goel in Ophthalmology Fact Fixer, 2017
Steven-Johnson's syndrome refers to acute inflammation of the skin and mucous membrane. Lesion confined to the skin is called erythema multiforme. The skin lesion typically appears as target lesions. Mucopurulent ocular discharge is common at the acute stage. Ocular complications are common and consist of dry eyes, Symblepharon and eyelid malposition.
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.
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.
A conjunctival-sparing surgical technique for lower eyelid cicatricial entropion repair in ocular cicatricial pemphigoid
Published in Orbit, 2020
Hokyung Choung, Edith R. Reshef, Thidarat Tanking, Suzanne K. Freitag
Five patients were included: a 44-year-old female, a 60-year-old male, an 80-year-old male, a 90-year-old female, and a 93-year-old female. All had biopsy proven OCP and all were actively receiving immunomodulatory drugs and were in remission with minimal or no active disease at the time of surgery. All patients were symptomatic from lashes abrading the ocular surface secondary to mild to moderate cicatricial lower lid entropion, and had tarsal and conjunctival fibrosis without obliteration of their inferior fornices by significant symblepharon. One patient had mild, early symblepharon formation. All underwent successful entropion repair via the conjunctival-sparing technique described herein. Additional anatomic factors contributing to entropion including horizontal eyelid laxity and orbicularis oculi override were surgically addressed. All patients were treated with perioperative oral steroids and antibiotic ointment. There were no surgical complications in any of the cases. After surgery, all patients reported substantial improvement in ocular discomfort and on examination there were no recurrences of entropion, no overcorrections, and no exacerbations of ocular surface inflammation with follow-up periods of 22, 18.5, 12.5, 10 and 6.5 months (average 13.9 months).
Related Knowledge Centers
- Ankyloblepharon
- Conjunctiva
- Eyelid
- Rosacea
- Trachoma
- Sclera
- Mucous Membrane Pemphigoid