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Ocular Pemphigoid

This is a condition of progressive shrinking and inflammation of the conjunctiva. It occurs more in older patients. Sometimes skin blisters are seen, and blisters can be seen inside the mouth.

Certain ocular drops have been associated with ocular pemphigoid. These include Propine, Timoptic, Phosopholine Iodine, Idoxuridine, and Pilocarpine. (All these medications are used to treat glaucoma on a long term basis.).

It seems to be associated with antoimmunity, as antibodies have been found to the basement membrane of the conjunctiva. Sometimes these antibodies can be found in the blood, too.

Phemphigoid causes damage to the eye by a progressive inflammation and scarring. This damages the accessary tear ducts, and a dry eye results. There seems to be a stage of inflammation characterized by redness, discharge, and swelling. This is followed by scarring associated with dry eye.

You can see scars between the inside of the lower lid and the surface of the eye by pulling the lower lid out and having the patient look up. A band of tissue can be seen this way.

Treatment is very difficult. During the inflammatory stage antibiotics, steroids, systemic antiflammatory drugs may all help. Sometimes a glass rod may be run under the lids to break scars. It is good to stop the offending glaucoma drop if possible, but many times this is simply not possible because of the coexisting glaucoma. In the scarring phase artificial tears are necessary.