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Cicatricial pemphigoid and erythema multiforme.

B J Mondino1

  • 1Jules Stein Eye Institute, UCLA School of Medicine 90024.

Ophthalmology
|July 1, 1990
PubMed
Summary

Cicatricial pemphigoid (CP) and erythema multiforme (EM) are severe bullous diseases affecting the conjunctiva. Treatments range from supportive care to systemic immunosuppression for these chronic or acute inflammatory conditions.

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Area of Science:

  • Ophthalmology
  • Dermatology
  • Immunology

Background:

  • Cicatricial pemphigoid (CP) and erythema multiforme (EM) are bullous diseases frequently and severely affecting the conjunctiva.
  • CP is a chronic, progressive condition in the elderly, causing severe ocular complications like symblepharon and vision loss.
  • EM is an acute, self-limited disorder in young individuals, with potential for scarring and vision-impairing sequelae.

Purpose of the Study:

  • To differentiate the clinical presentation, pathogenesis, and management of Cicatricial Pemphigoid (CP) and Erythema Multiforme (EM) concerning conjunctival involvement.
  • To highlight the unique challenges and severe outcomes associated with these bullous diseases in the ocular tissues.

Main Methods:

  • Review of clinical characteristics, histopathology, and immunopathology of CP and EM.
  • Analysis of conjunctival manifestations, including symblepharon, entropion, trichiasis, and dry eye.
  • Examination of treatment strategies for both conditions, from supportive measures to systemic therapies.

Main Results:

  • CP presents with subepithelial blisters and basement membrane deposition, leading to chronic conjunctival shrinkage and vision impairment.
  • EM involves subepithelial bullae and perivascular infiltrates, with potential for scarring and ankyloblepharon after acute episodes.
  • Both diseases require multifaceted management, including lubrication, antibiotics, surgical correction, and immunosuppression.

Conclusions:

  • CP and EM represent the most frequent and severe bullous diseases affecting the conjunctiva, necessitating prompt and appropriate management.
  • Understanding the distinct pathophysiologies of CP and EM is crucial for effective treatment and prevention of irreversible ocular damage.
  • Ocular involvement in these bullous diseases underscores the importance of a multidisciplinary approach involving ophthalmologists, dermatologists, and immunologists.

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