Chronic cicatrizing conjunctivitis: A review of the differential diagnosis and an algorithmic approach to management

Vazirani, Jayesh; Donthineni, Pragnya Rao; Goel, Sahil; Sane, Sayali; Mahuvakar, Sheetal; Narang, Purvasha; Shanbhag, Swapna S; Basu, Sayan

doi:10.4103/ijo.ijo_604_20

Cited by 25 publications

(20 citation statements)

References 42 publications

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“…Shanbhag et al recently published a scoring system to ensure correct diagnosis of SJS/TEN in patients who present with advanced CCC (14). Vazirani et al have used this scoring system in an algorithm to reach a specific diagnosis in eyes with CCC thus helping in appropriate decision-making regarding further medical and surgical interventions in these eyes (15).…”

Section: Diagnosis Of Sjs/ten In the Chronic Phase Of Advanced Cicatricial Conjunctivitismentioning

confidence: 99%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

et al. 2021

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Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of rare, severe immunological blistering skin reactions which are triggered by medication intake or infections. The acute phase is characterized by necrolysis of the skin and desquamation of mucosa, primarily oral and ocular, with significant mortality rates. The chronic phase is characterized by multi-organ sequelae with increased rates of morbidity and reduced quality of life for patients who have survived the acute phase. Since the primary goal in the acute phase is saving the life of the patient, ocular involvement is often missed and a significant proportion of patients present to an ophthalmologist with the chronic ocular sequelae. In India, chronic ocular sequelae and low vision are observed in two-thirds of patients who present in the chronic phase of SJS/TEN. In the chronic phase of ocular involvement, there are definite windows of opportunity which if targeted with specific interventions such as scleral lenses and mucous membrane grafts can help reduce the incidence of corneal blindness and improve the quality of life for patients with SJS/TEN. Over the last decade, several studies from India have advanced the understanding of the natural course of ocular involvement in SJS/TEN and the outcomes of timely interventions in the chronic phase of the disease. We present an overview of the epidemiology of ocular complications of SJS/TEN in India, the specific challenges faced in the management of ocular complications in the acute stage and recent advances in management of the chronic ocular complications of the disease.

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Section: Diagnosis Of Sjs/ten In the Chronic Phase Of Advanced Cicatricial Conjunctivitismentioning

confidence: 99%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

et al. 2021

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“…In patients with OCP, an algorithmic approach to management was implemented. 15 For patients with DED, ocular surface stabilization was achieved by measures suggested by the TFOS-DEWS II management and therapy report. 16…”

Section: Methodsmentioning

confidence: 99%

“…14 In patients with OCP, an algorithmic approach to management was implemented. 15 For patients with DED, ocular surface stabilization was achieved by measures suggested by the TFOS-DEWS II management and therapy report. 16 Limbal stem cell transplantation is required for patients presenting with LSCD secondary to chemical injuries.…”

Section: Preoperative Work-upmentioning

confidence: 99%

Visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders

Aggarwal,

Gour,

Gupta

et al. 2024

J Cataract Refract Surg

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PURPOSE: To determine the visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders. SETTING: Tertiary eye care centre in North India DESIGN: Retrospective observational study METHODS: Patients with various ocular surface disorders with stabilized ocular surfaces who underwent cataract surgery during this period and had a minimum postoperative follow-up of six weeks were included. The primary outcome measures were post-operative best corrected visual acuity at six weeks, best BCVA and postoperative complications. RESULTS: The study included 20 men and 24 women. A total of 55 eyes were evaluated: Steven-Johnson syndrome (SJS) 35 eyes, Ocular Cicatricial Pemphigoid (OCP) four eyes, eight eyes with Dry Eye Disease (DED), six eyes with chemical injury and two eyes with Vernal Keratoconjunctivitis (VKC). The mean duration of ocular surface disorder was 33.9 ± 52.17 months. The median preoperative BCVA was 2.0 (IQR, 1.45 to 2.0). The median BCVA ever achieved was 0.50 (IQR, 0.18 to 1.45) at 2 months and the median BCVA at 6 weeks was 0.6 (IQR, 0.3 to 1.5). Maximum improvement in BCVA was noted in patients with DED and SJS and the least in OCP. Phacoemulsification was performed in 47.27% eyes with intraoperative complications noted in 9% eyes. Post-operative surface complications occurred in 12 (21.82%) eyes. Other postoperative complications occurred in 9 (16%) eyes. CONCLUSION: Cataract surgery outcome can be visually rewarding in patients with ocular surface disorders provided ocular surface integrity is adequately maintained preoperatively and postoperatively.

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“…2,4,5 Although ocular MMP is the most common cause of CCC in developed countries, 2,6,7 CCC can also occur due to other etiologies such as drug-induced cicatrizing conjunctivitis, Stevens-Johnson syndrome, and atopic keratoconjunctivitis. 8,9 Various other causes of CCC and MMP share similar clinical features, but it is important to distinguish these conditions to arrive at the correct etiological diagnosis. 8,[10][11][12] This is because the treatment and prognosis vary greatly based on the underlying cause.…”

mentioning

confidence: 99%

“…8,9 Various other causes of CCC and MMP share similar clinical features, but it is important to distinguish these conditions to arrive at the correct etiological diagnosis. 8,[10][11][12] This is because the treatment and prognosis vary greatly based on the underlying cause. Systemic immunomodulatory therapy is the first line of treatment of active ocular MMP, 2 and it is important to diagnose this condition at the earliest to initiate treatment and to stop progressive cicatrization, thus preventing long-term ocular sequelae.…”

mentioning

confidence: 99%

Direct Immunofluorescence Findings and Factors Affecting Conjunctival Biopsy Positivity in Ocular Mucous Membrane Pemphigoid

Jain,

Jakati,

Shanbhag

et al. 2023

Cornea

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Purpose: The aim of this study was to describe the direct immunofluorescence (DIF) findings and factors affecting conjunctival biopsy positivity in patients clinically diagnosed with ocular mucous membrane pemphigoid (OMMP). Methods: This retrospective observational case series included patients with clinical OMMP who underwent conjunctival biopsy for DIF in at least 1 eye between 2018 and 2021 in an institutional setting. The primary outcome measures were association of age and chronic ocular complications with biopsy positivity. Results: Of 61 patients, DIF positivity was seen in 33 (54.1%) clinically suspected cases of OMMP. Of 39 patients who underwent bilateral biopsy, 23 (59%) were positive, of which 12 (52%) were positive in both eyes while 11 (48%) were positive in 1 eye. Of 22 patients who underwent unilateral biopsy, 10 (45%) were positive. Of the 100 biopsied eyes, 45 (45%) were DIF positive. Among the immunoreactants studied, linear deposition of C3 was seen in all 45 positive eyes (100%). Increasing age was significantly associated with higher likelihood of biopsy negativity (P = 0.032), whereas a greater Sotozono chronic ocular complication score, indicative of disease severity, was associated with low likelihood of biopsy positivity (P = 0.0042) and lower overall expression of immunoreactants on DIF (P = 0.0007). Conclusions: Older patients and patients with more severe ocular surface disease sequelae are likely to have negative DIF results. To optimize the chances of confirming the diagnosis of OMMP by DIF, both eyes should be biopsied early in the disease course. If 1 eye is being biopsied, the less affected eye must be chosen.

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Chronic cicatrizing conjunctivitis: A review of the differential diagnosis and an algorithmic approach to management

Cited by 25 publications

References 42 publications

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

Visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders

Direct Immunofluorescence Findings and Factors Affecting Conjunctival Biopsy Positivity in Ocular Mucous Membrane Pemphigoid

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