[Mucous membrane pemphigoid with ocular involvement. Part II: therapy]

Area of Science:

• Ophthalmology
• Immunodermatology

Context:

• Mucous membrane pemphigoid (MMP) is a chronic autoimmune blistering disease affecting mucous membranes, particularly the conjunctiva.
• Ocular involvement can lead to significant morbidity, including cicatricial changes and vision loss.

Purpose:

• To outline current treatment strategies for conjunctival mucous membrane pemphigoid (MMP).
• To discuss the role of systemic immunosuppression and topical therapies in managing ocular surface disease.
• To highlight surgical considerations and the importance of multidisciplinary care.

Summary:

• Systemic immunosuppression is the cornerstone of MMP treatment, aiming to reduce conjunctival inflammation.
• Pharmacological options include corticosteroids, dapsone (mild-moderate), cyclophosphamide (severe), methotrexate, azathioprine, mycophenolate mofetil, and monoclonal antibodies (daclizumab, rituximab).
• Surgical interventions address eyelid abnormalities (entropion, trichiasis) and secondary complications (cataract, glaucoma), but should be performed after controlling inflammation.

Impact:

• Establishes a framework for managing ocular MMP, emphasizing a stepwise approach based on disease severity.
• Underscores the need for collaborative care between ophthalmologists, dermatologists, and internists for optimal patient outcomes.
• Provides insights into the efficacy of various immunosuppressive agents and the timing of surgical interventions.