Management of ocular mucous membrane pemphigoid

Mucous membrane pemphigoid (MMP) is an immune-mediated systemic disease affecting the mucosa of the mouth, eyes, nasopharynx, GI tract, genitalia and skin. Chronic inflammation and subepithelial blisters of the mucosa result in progressive scarring. Ocular MMP is characterized by a chronic cicatrizing conjunctivitis, which leads to symblepharon, entropion, trichiasis, severe dry eye, cornea ulceration and potential blindness when untreated. One of the most effective treatments for ocular MMP is the combination therapy of cyclophosphamide (administered for 12-18 months) and oral corticosteroids (tapered over 3-4 months). This regimen has proven effective in controlling conjunctival inflammation, halting mucosal scarring and preventing potential vision loss, and is typically used for severe disease. Long-term drug-free remission is achievable in patients with this regimen. For all immunosuppressive medications, careful monitoring for drug-related side effects is crucial.