Accidental Discovery of Ocular Cicatricial Pemphigoid

Ocular cicatricial pemphigoid (OCP) is a chronic systemic autoimmune dermatosis characterized by progressive and fibrosing inflammation of the conjunctiva. We report the case of a 54-year-old female patient who presented with bilateral and progressive visual acuity loss. Clinical examination revealed trichiasis, bilateral symblepharon, bilateral superficial punctate keratitis, corneal opacity, and bilateral cataracts. Systemic evaluation identified erosive gingivitis and scarred bullous lesions. Histopathological and immunofluorescence examinations confirmed the diagnosis of OCP. The patient was treated with oral corticosteroids, bolus cyclophosphamide, dexamethasone eye drops, and moisturizing agents. Symblepharon surgery and photoablation of the trichiasic eyelashes were performed after three months. At 12 months, no recurrence was observed, and cataract surgery was proposed following a 6-month remission period. OCP is a systemic, progressive, and potentially blinding condition requiring early and multidisciplinary management to control inflammation and improve outcomes. However, it's frequently diagnosed late, especially in the absence of significant visual acuity loss, highlighting the need for increased clinical vigilance.