The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

Area of Science:

• Ophthalmology
• Immunology

Background:

• Cicatrizing conjunctivitis encompasses diverse conditions, with ocular mucous membrane pemphigoid (MMP) being a leading cause in developed nations.
• Understanding MMP's pathogenesis is crucial for managing this inflammatory eye disease.

Purpose of the Study:

• To review conditions causing cicatrizing conjunctivitis, focusing on ocular MMP.
• To re-evaluate MMP pathogenesis, proposing a revised hypothesis on autoimmune mechanisms.
• To discuss current and future therapeutic strategies for ocular MMP.

Main Methods:

• Literature review of 35 conditions causing cicatrizing conjunctivitis.
• Analysis of clinical characteristics, demographics, and signs of ocular MMP.
• Evaluation of research on aldehyde dehydrogenase (ALDH) and retinoic acid (RA) in MMP fibrosis.

Main Results:

• Ocular MMP is the most common cause of cicatrizing conjunctivitis.
• A revised hypothesis on autoimmune mechanisms driving conjunctival inflammation in MMP is presented.
• ALDH and RA play roles in MMP profibrotic activity, suggesting potential antifibrotic therapies.

Conclusions:

• Effective management of ocular MMP requires addressing ocular surface health and systemic immunomodulatory therapy.
• Future research should focus on improved diagnostics, disease activity markers, and novel topical/biological therapies for inflammation and scarring.