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Updated: Aug 22, 2026
Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Ocular cicatricial pemphigoid review
C Stephen Foster1, Maite Sainz De La Maza
1Department of Ophthalmology, Harvard Medical School, Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA. fosters@uveitis.org
Purpose Of Review:
Ocular mucous membrane pemphigoid produces progressive cicatrizing conjunctivitis; this can result in scarring of the conjunctiva and cornea.
Recent Findings:
Increased expression of macrophage-colony-stimulating factor, collagen-binding heat shock protein 47, transforming growth factor-beta1, IL-4, IL-5, and macrophage migration inhibitory factor may enhance both conjunctival inflammation and conjunctival scarring. Recent developments on mucous membrane pemphigoid medical therapy include the efficacious effect of daclizumab, intravenous immunoglobulin therapy, and methotrexate. Subconjunctival mitomycin has proved not to be efficacious in controlling long-term, conjunctival inflammation and scarring. The Boston scleral lens enhances vision, reduces the disabling ocular pain and photophobia, and helps to heal persistent epithelial defects, reducing recurrence of defects. Recent developments on mucous membrane pemphigoid surgical therapy include keratolimbal allografts and amniotic membrane transplantation, with or without penetrating keratoplasty for ocular surface reconstruction in total stem cell deficiency. The prognosis is strongly influenced by preoperative conditions such as tear function and functional external ocular adnexae, and by postoperative conditions such as persistent inflammation, severe dry eye, or rejection of the keratolimbal allograft. Some authors find efficacious the use of amniotic membrane transplantation for reconstruction of the conjunctival fornices provided systemic immunosuppression is pre- and post-operatively used.
Summary:
The use of daclizumab or intravenous immunoglobulin therapy, the better selection of candidates for surgical interventions, and the better pre- and post-operative management of keratolimbal allograft and amniotic membrane transplantation may improve visual rehabilitation in the patients with ocular mucous membrane pemphigoid.
Insights
Ocular mucous membrane pemphigoid causes scarring of the conjunctiva and cornea. Medical therapies like daclizumab and surgical options like keratolimbal allografts show promise for visual rehabilitation.
Area of Science:
- Ophthalmology
- Immunodermatology
Background:
- Ocular mucous membrane pemphigoid (OMMP) leads to progressive cicatrizing conjunctivitis, causing conjunctival and corneal scarring.
- Key molecular factors like macrophage-colony-stimulating factor and TGF-β1 may contribute to inflammation and scarring.
Purpose of the Study:
- To review recent advancements in the medical and surgical management of ocular mucous membrane pemphigoid.
- To identify factors influencing prognosis and visual rehabilitation in OMMP patients.
Main Methods:
- Review of current literature on medical therapies including daclizumab, IVIg, and methotrexate.
- Evaluation of surgical interventions such as amniotic membrane transplantation and keratolimbal allografts.
- Analysis of prognostic indicators and postoperative management strategies.
Main Results:
- Daclizumab, intravenous immunoglobulin (IVIg) therapy, and methotrexate demonstrate efficacy in medical management.
- Subconjunctival mitomycin is not effective for long-term control of inflammation and scarring.
- Boston scleral lenses improve vision and ocular comfort; amniotic membrane transplantation and keratolimbal allografts are used for ocular surface reconstruction.
- Prognosis is influenced by preoperative tear function and postoperative inflammation or graft rejection.
Conclusions:
- Daclizumab or IVIg therapy, improved surgical candidate selection, and optimized perioperative care for grafts can enhance visual outcomes.
- Careful patient selection and management are crucial for successful surgical interventions in OMMP.
