Conjunctiva
Ocular Mucous Membrane Pemphigoid
Also known as: OMMP, ocular cicatricial pemphigoid, OCP, cicatrising conjunctivitis, symblepharon, mucous membrane pemphigoid eye, conjunctival scarring, fornix shortening
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A chronic autoimmune cicatrising conjunctivitis that can progressively scar the ocular surface. Look for symblepharon, fornix shortening, conjunctival shrinkage, entropion, trichiasis, keratinisation, severe dry eye, recurrent epithelial breakdown, and corneal vascularisation or opacification. The safety task is to avoid treating progressive scarring as simple dry eye, allergy, or blepharitis alone. Suspected ocular mucous membrane pemphigoid needs ophthalmology / ocular surface specialist referral and systemic disease consideration.
Recognition
Symptoms: what patients report
- Chronic redness, irritation, burning, foreign-body sensation, dryness, or recurrent gritty discomfort.
- Recurrent episodes labelled as conjunctivitis, blepharitis, or dry eye with incomplete response.
- Photophobia or blurred vision when corneal involvement, epithelial breakdown, or severe surface disease develops.
- Symptoms may be bilateral but asymmetric; early disease can appear unilateral.
- History may include oral ulcers, skin/mucosal blistering, autoimmune disease, or prior diagnosis of mucous membrane pemphigoid, but ocular disease can be the presenting clue.
Signs: what the examination shows
- Subepithelial conjunctival fibrosis, symblepharon, or progressive forniceal shortening.
- Loss of normal inferior fornix depth or difficulty sweeping the fornix.
- Entropion, trichiasis, lid margin keratinisation, or lashes abrading the cornea.
- Severe dry eye, reduced tear meniscus, conjunctival inflammation, punctate epithelial erosions, or recurrent epithelial defects.
- Corneal vascularisation, scarring, keratinisation, or epithelial instability in advanced disease.
- Mucus strands and chronic inflammation may be present but purulent discharge is not the primary pattern.
What OptoGuide™ covers for ocular mucous membrane pemphigoid
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Ocular Cicatricial Pemphigoid (Mucous Membrane Pemphigoid) — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Mucous Membrane Pemphigoid and Pseudopemphigoid. Thorne JE, Anhalt GJ, Jabs DA. Ophthalmology. 2004;111(1):45-52.
- Challenges and advances in ocular mucous membrane pemphigoid (OMMP); from pathogenesis to treatment strategies. Ghanbari H, Rahimi M, Momeni A, et al. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrec
- Ocular Mucus Membrane Pemphigoid: A Primary Versus Secondary Entity. Philip AM, Fernandez-Santos CC, Ramezani K, et al. Cornea. 2023;42(3):280-283.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.