Good Hope Eye Clinic

Cicatrising conjunctivitis

David Kinshuck from Congress notes after Dart 2106

 

Causes of cicatrising conjunctivitis

  • 60% mucous membrane pemphigoid (mmp)
  • 20% Stevens Johnson Syndrome (sjs)
    • in Sjs cicatrising conjunctivitis can rarely develop years later, or recur years later
  • some eye drops (benzalkonium or Iopidine)
    • if caused by drops, stopping the drops, makes the condition better
  • other causes include rosacea,  akc,  trachoma  sarcoid, lichen planus, and others 

At onset

  • Stop glaucoma drops, dorzolamide....use diamox or Iopidine,
  • Time..when did it start etc
  • ask about other mucous membranes
  • refer if conjunctiva scarred and or inflamed and don't know cause
  • biopsy..conj, mouth..buccal,...don't take from fornix,

Mucous membrane pemphigoid

  • Ocular or oral ,e.g. linear iga
  • 3 groups of scarring disease
    • gp1,  gp2 neoplasia, gp 3 milder scarring...drug induced,ocular,systemic
  • Gp1 needs systemic treatment,
  • Pemphigoid..subepithelial
  • differential diagnosis at the onset includes
    • the onset acute limbitis,
    • recurring conjunctivitis
    • scarring
    • surface neoplasia,
  • Mmp...25% eye only
  • 1/100000 incidence, Older patients, Antibodies to bp 180
  • Control inflammation, get control with systemic treatment
  • side effects of treatment are a big problem
  • Rituximab, mycophhenolate (15% side effects), cyclophosphamide and steroids,
    IV immunoglobulin
  • Prednisolone..too many side effects
  • Dapsone, sulfapyridine,  if mild
  • if severe Rituximab, cyclophosphamide (safe for short period), iv immunoglobulin
  • Scarring due to inflammation,
  • Disulfram stops scarring

 

Cicatrising conjunctivitis

  • review Eye17
  • > 60% mmp
  • LOOK AT FORNICES
  • pain ulceration at other sites
    ? 2 diseases
  • Without systemic 30%
  • Dry eye, rosacea,
    Investigate off steroid
  • biopsy, immunofluoresce
  • Take normal tissue, bulbar conjunctiva, buccal mucosa,
  • Topical steroids, avoid in mmp...systemic treatment, if get infection, dont see infiltration
  • Systemic treatment
    • Cyclophosphamide and systemic steroids , mycophenylate, dapsone..mild, sulphapyridine, rituxamide , intravenous globulin, Basement membrane proteins attacked, T and b cells, scarring from fibroblasts, Current therapy,
  • Tacrolimus not effective