Local Ocular Treatment of Mucous Membrane Pemphigoid
Treatment of mucus membrane pemphigoid involves both topical and systemic therapy according to the needs of each individual patient. The role of topical therapy is try to minimize the inflammation on the surface of the eye and to try to re-establish the best tear film possible. To control the inflammation, topical steroids may be useful. Topical steroids have side effects, which limit their long-term use. Cyclosporine and lifitegrast are other medications that can control inflammation and improve the tear film. They have a better safety profile for extended use. To replace the tear film, which is so damaged by MMP, artificial tears are very helpful. Because they are often needed frequently, preservative-free uni-dosed preparations are recommended to avoid toxicity from commonly used multi-dosed preserved tear preparations. Punctal plugs or cautery help increase the quantity of tears by blocking the outflow of the tears. This keeps the eye more moist. Treatment of eyelid inflammation also helps the quality of the tears produced and include warm compresses, antibiotic ointment, lid scrubs and oral doxycycline. In some cases, autologous serum are recommended. These are made from the patient’s blood and add significant healing properties. The ocular surface can also be protected and supported with specialty contact lenses, such as the PROSE lens which also can enhance the patients vision compared to glasses.
When patient’s vision is reduced by corneal scarring surgical intervention is sometimes used after the ocular inflammation is controlled with topical and systemic therapy and the position of the lids/lashes is optimized. Such surgery includes superficial keratectomy to remove scarring under the surface of the cornea, corneal transplantation with a human donor cornea or with an artificial plastic cornea (keratoprothesis).