Managing Ocular Cicatricial Pemphigoid: A Case Study from TOSCON 2024

A 64-year-old female presented with ocular symptoms, diagnosed with Ocular Cicatricial Pemphigoid at the 9th Annual State Ophthalmological Conference (TOSCON) 2024. Treatment included topical lubricants, anti-inflammatory agents, immunomodulators, and mini-scleral lens fitting. The patient showed symptomatic relief, corneal healing, and improved vision outcomes.

• Ocular Cicatricial Pemphigoid
• TOSCON 2024
• Case Study
• Treatment
• Mini-Scleral Lens

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1. Manoj Mathur E-Poster 9thAnnual State Ophthalmological Conference TOSCON 2024 12thto 14thJuly, 2024 at Katriya Hotel & Towers, Hyderabad STRUGGLE TO FILL UP THE LAKE OF PERSISTENT EPITHELIAL DEFECT REFERENCES 1) Schonberg S, Stokkermans TJ. Ocular Pemphigoid. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan 2) Golhait P, Peseyie R. Persistent Epithelial Defect. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan 3) Kumar M, Shetty R, Jayadev C. Role of mini- scleral lens in mucous membrane pemphigoid. Indian J Ophthalmol. 2017 Apr;65(4):320-322. doi: 10.4103/ijo.IJO_730_16. DR. SHAIMA SALEEM DNB OPHTHALMOLOGY ACKNOWLEDGEMENT DR. M.L. KARTHIKA

2. Manoj Mathur E-Poster STRUGGLE TO FILL UP THE LAKE OF PERSISTENT EPITHELIAL DEFECT DR. SHAIMA SALEEM 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad CASE A 64yrs old female came with complaints of Redness, burning sensation and diminished vision in Right eye. EXAMINATION - BCVA - RE 6/60 & LE 6/6 On Slit-Lamp, Both eyes showed congestion, Forniceal shortening with sub-conjunctival scarring. RE large 5 x 5.8 mm central corneal Epithelial defect with subepithelial scar + PCIOL. LE - within normal limits with PCIOL.

3. Manoj Mathur E-Poster STRUGGLE TO FILL UP THE LAKE OF PERSISTENT EPITHELIAL DEFECT DR. SHAIMA SALEEM 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad Conjunctival Biopsy confirmed Ocular Cicatricial Pemphigoid Topical lubricants + Topical Anti- inflammatory and lubricants Systemic & Topical immunomodulators Managed along with Rheumatologist Double layered Amniotic membrane grafting with glue + Bandage Contact Lens Bandage Contact Lens Mini-Scleral Contact Lens

4. Manoj Mathur E-Poster STRUGGLE TO FILL UP THE LAKE OF PERSISTENT EPITHELIAL DEFECT DR. SHAIMA SALEEM 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad RESULTS Patient was symptomatically relieved Corneal epithelial defect healed with sub-epithelial scar RE BCVA 6/36 Need for topical medications reduced MINI SCLERAL LENS GOOD FIT

5. Manoj Mathur E-Poster STRUGGLE TO FILL UP THE LAKE OF PERSISTENT EPITHELIAL DEFECT DR. SHAIMA SALEEM 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad Ocular cicatricial pemphigoid experience a bilateral, chronic conjunctivitis that has remissions & exacerbations. In the beginning, patients experience ocular redness, tearing, burning, light sensitivity, and foreign body sensation; similar to dry eye syndrome. Corneal signs include punctate epithelial erosions, epithelial defects, exposure keratitis, ulcer and vascularisation.There is minimal to no discharge present, differentiates from infectious causes. As the disease progresses, the signs become pathognomic, most notably development of a symblepharon. The standard medical treatment protocol for Persistent Epithelial Defect begins with aggressive lubrication using preservative-free artificial tears and sterile ocular ointments, insertion of punctal plugs increases the retention of lubricants, Cyanoacrylate glue & Bandage soft contact lenses (BCL). Refractory cases may be managed by Amniotic membrane grafting, Autologous serum, Scleral Contact Lens & Limbal stem cell transplantation. Advantages of Mini - Scleral lenses Protects entire cornea against irritants & friction, supported by sclera, maintains post-lens reservoir that continuously lubricants the cornea allowing epithelial defects to heal.

6. Manoj Mathur E-Poster STRUGGLE TO FILL UP THE LAKE OF PERSISTENT EPITHELIAL DEFECT DR. SHAIMA SALEEM 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad CONCLUSION A case of persistent epithelial defect which was diagnosed as Ocular Cicatricial pemphigoid can be managed with mini-scleral contact Lens. Proper Diagnosis and Best suitable line of treatment offered even in old age significantly improves patient s quality of life. Ocular Cicatricial Pemphigoid - Need not be only medically managed - But also other conservative or surgical options should be weighed to provide patient with better quality care.