Abstract ID: 26-353
Mucous Membrane Pemphigoid: Mimicker of Multiple Pathologies
Author: Cornelia Poitelea Base Hospital / Institution: University Hospitals Sussex
Presentation Type: ePoster Presentation
Purpose
Cicatricing conjunctival conditions can be missed by general ophthalmologists, presenting with entropion, trichiasis and/or chronically inflamed eye. Diagnosis of mucous membrane pemphigoid is one differential diagnosis and early treatment is essential in preventing structural changes in the conjunctiva, fornix shortening and limbal stell cell deficiency. This presentation aims to increase awareness about this condition and share a summary of a few cases that had delayed diagnosis, highlighting key factors that may contribute to optometrists and ophthalmologists picking up on red flags during initial consultations
Methods
We present 3 cases that had delayed diagnosis and were initaly diagnosed as trichiasis due to dermatochalasis, entropion and glaucoma drop allergy. We also summarise the key points about mucous membrane pemphigoid (MMP) and differential diagnosis, as well as current approach to diagnoses and treatment.
Results
Conjunctival biopsy was positive in 2/3 cases. Due to high clinical suspicion, patients were started on systemic and surgical treatment. The cases were managed by a multidisciplinary team involving ophthalmologists and rheumathologist that oversaw the immunosuppression. All patients required eyelid surgery. One patient presented required buccal mucosa graft fornix reconstruction and multiple eyelid surgeries. All patients had other pathologies and were very elderly at the time of presentation.
Conclusion
MMP is a chronic relentless condition which requires specific immunosupression and surgical treatment. Delayed/misdiagnosis happens often. Tissue biopsy is not always positive. When clinical suspicion is high, treatment should be discussed with patients and promptly started, in order to prevent scarring and ankyloblepharon. In established cases, mucosal graft is necessary to reconstruct the fornix. Risk of eyelid malposition remains high longterm. In patients with glaucoma drop allergy signs can overlap with the presentation of mucous membrane pemphigoid, causing delayed recognition of the condition and irreversible structural changes and fibrosis.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Roshni | Sawh | University Hospitals Sussex |
| Raisah | Owasil | University Hospitals Sussex |