Treatment of the Eyelids of Patients with Mucous Membrane Pemphigoid

The eyelids are anatomically connected to the eyes, and are almost always involved in ocular pemphigoid. The level of eyelid disease is variable, with each patient presenting and evolving differently. Inflammation and scarring can occur on the inside of the eyelids, in a layer of tissue called the conjunctiva that covers the eyeball as well. Many glands that contribute to tears exist within this tissue. Damage can lead to dry eyes, corneal abrasions, and other eye surface
problems as outlined above. When the dry eye problems are severe enough, the oculoplastic surgeons may even close the opening to the tear drainage ducts to maintain tears on the surface of the eye ball thereby increasing eye lubrication. Sometimes, however, the disease itself causes these structures to scar on their own.

If the disease progresses there can be scarring between the lids and the eyes. This may result in pain and double vision, in which case the lids and eyes need to be surgically separated with tissue grafts usually harvested from the mouth of the patient placed between them. Scarring in the lids can direct the eyelashes against the eye ball causing further discomfort related to corneal abrasions and possible infection. This can be surgically corrected to reform the in turned eyelid margin and turn it away from the eyeball itself. If the issue is abnormal eyelashes, these can be either cauterized or frozen to prevent them from growing in and irritating the eye.