Conjunctival scarring after eyelid surgery as first sign of ocular cicatricial pemphigoid

Diagnosis of ocular cicatricial pemphigoid (OCP), a chronic cicatrizing autoimmune disease of the conjunctiva, may be difficult in the early stages of the disease. We noted abnormal conjunctival scarring in three patients who had undergone eyelid and strabismus surgery, which caused us to suspect OCP. In all three patients who subsequently underwent conjunctival biopsy, immunoglobulin or complement in the basement membrane zone detected by direct immunofluorescence helped establish the diagnosis. Although OCP typically is a disease of the elderly, the three patients in this study were aged < 50 years; one patient was 19 years old. The present study demonstrates that a diagnosis of OCP should be considered for patients who develop abnormal conjunctival scarring after eyelid or strabismus surgery.