From the Guidelines
Pemphigus vulgaris can indeed cause eye irritation, though it's not the most common site of involvement, as supported by the most recent study 1 from 2024.
Overview of Pemphigus Vulgaris
Pemphigus vulgaris primarily affects mucous membranes and skin, and when it involves the eyes, it typically affects the conjunctiva (the membrane covering the eye). This can manifest as conjunctivitis with redness, burning, itching, and a feeling of grittiness. In severe cases, it may lead to corneal ulceration or scarring.
Clinical Presentation and Management
The clinical signs and management of conjunctivitis in pemphigus vulgaris are crucial for preventing long-term sequelae. According to the study 1, topical corticosteroid therapy may aid in controlling acute conjunctival inflammation, but systemic immunosuppressive therapy is required to inhibit inflammation, prevent keratopathy, and prevent progression of conjunctival scarring.
- Key points in management include:
- Topical corticosteroid eye drops like prednisolone acetate 1% may be prescribed 4-6 times daily during acute phases.
- Lubricating artificial tears to reduce irritation.
- Systemic therapy for the underlying pemphigus is essential and typically includes oral corticosteroids (prednisone 1-2 mg/kg/day) and steroid-sparing immunosuppressants like azathioprine, mycophenolate mofetil, or rituximab.
- Patients should avoid rubbing their eyes, use preservative-free eye drops if possible, and seek immediate medical attention if they experience vision changes, severe pain, or increased light sensitivity.
Importance of Multidisciplinary Care
Treatment for ocular involvement in pemphigus vulgaris should be managed by both a dermatologist and an ophthalmologist, as emphasized in the study 1. This multidisciplinary approach ensures comprehensive care for the patient, addressing both the skin and eye manifestations of the disease.
Recent Guidelines and Recommendations
The most recent guidelines from 2024 1 highlight the importance of aggressive treatment of associated dry eye state and the consideration of mucous membrane or amniotic membrane grafting for fornix reconstruction in advanced disease. Additionally, the study notes that ocular procedures such as cataract surgery may worsen the disease, and perioperative immunosuppression and close postoperative follow-up are warranted in such cases.
Conclusion is not allowed, so the answer ends here.
From the Research
Pemphigus Vulgaris and Eye Irritation
- Pemphigus Vulgaris (PV) is an autoimmune disease that can cause eye irritation, although ocular involvement is rare 2, 3, 4.
- The most common ocular manifestations of PV include conjunctivitis, conjunctival hyperemia, erosions on the eyelids, and palpebral/bulbar conjunctiva 3, 4.
- Associated symptoms of ocular PV include local pain/stinging, irritation, photophobia, and epiphora 3.
- Ocular PV can be treated with systemic and adjuvant topical therapies, and usually follows a benign course 3, 4.
- In some cases, ocular involvement in PV can lead to severe complications, such as corneal ulceration and perforation, despite immunosuppressive therapy 2.
Ocular Involvement in Pemphigus Vulgaris
- Ocular involvement in PV is often preceded by skin or mucosal lesions, and can occur during flares of mucocutaneous pemphigus 3, 4.
- The conjunctiva, eyelids, or both can be affected in ocular PV, but visual acuity is usually not affected 3, 4.
- Suprabasal acantholysis and deposition of IgG on epithelial cell surface can be observed in ocular PV 4.
- Ocular PV can recur, but patients often have full recovery without sequelae 4.
Treatment of Ocular Pemphigus Vulgaris
- Systemic therapy with prednisone and immunosuppressants, such as azathioprine, cyclosporine, or cyclophosphamide, can be effective in treating ocular PV 2, 5.
- Adjuvant topical therapies can also be used to treat ocular PV 3, 4.
- The choice of treatment regimen depends on the severity of the disease and the patient's response to therapy 5.