Ocular Mucous Membrane Pemphigoid Presenting as Recurrent Pterygium

Area of Science:

• Ophthalmology
• Immunodermatology

Background:

• Ocular mucous membrane pemphigoid (oMMP) is a rare autoimmune blistering disease affecting the conjunctiva.
• Recurrent pterygium is typically associated with environmental factors, but its association with oMMP is less understood.

Purpose of the Study:

• To investigate recurrent pterygium as a potential presenting feature of oMMP.
• To highlight the importance of considering oMMP in patients with recurrent pterygia.

Main Methods:

• Retrospective review of patients with biopsy-proven oMMP presenting with recurrent pterygia.
• Collection of demographic, clinical, and surgical intervention data.
• Conjunctival biopsy with direct immunofluorescence for diagnosis.

Main Results:

• Five male patients (median age 63) with recurrent pterygia were identified.
• 80% had a history of pterygium surgery; 60% developed recurrent pterygia.
• Signs of oMMP like symblepharon (67%) and forniceal shortening (100%) were common; 90% of biopsies were positive for oMMP.

Conclusions:

• Recurrent pterygium can be an initial manifestation of oMMP.
• Presence of symblepharon or forniceal shortening, especially in the fellow eye, necessitates a conjunctival biopsy.
• Prompt initiation of systemic immunomodulatory therapy (IMT) is vital to prevent disease progression.