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Updated: Jun 26, 2026

Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Abuse of vasoconstrictive eyedrops mimicking an ocular pemphigoid
C Tappeiner1, G-M Sarra, M Abegg
1Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
Purpose:
To describe conjunctival histopathologic alterations induced by excessive chronic astringent use.
Methods:
Report of a case with clinical picture, epicutane test results, histologic workup of conjunctival biopsy using conventional staining, and immunohistochemical markers.
Results:
A 45-year-old man using a phenylephrine preparation hourly for years presented with grotesque eye redness, fornix shortening, and scarring of puncta lacrimalia. Direct and indirect immunofluorescence were negative for ocular pemphigoid. Histology revealed signs of chronic inflammation and neovascularization in the conjunctiva. Symptoms resolved after cessation of therapy.
Conclusions:
Chronic abuse of decongestant eyedrops can produce a clinical picture resembling an ocular pemphigoid. Histology suggests that late onset immunoreaction and chronic vasoconstriction cause chronic inflammation and neovascularization, respectively.
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