Ocular Cicatricial Pemphigoid

WHAT IS OCULAR CICATRICIAL PEMPHIGOID?

Ocular cicatricial pemphigoid (OCP), also known as mucous membrane pemphigoid (MMP) is a condition where your immune system attacks the mucous membrane of the eye. This is known as an autoimmune condition.

The mucous membranes of the eye include the white part of our eye (the bulbar conjunctiva), and the inside of the eyelids (the palpebral conjunctiva). 

Although it is not well understood, OCP possibly results from a Type II hypersensitivity reaction of an antibody to an antigen that is located in the basement membrane of the conjunctival epithelium. 

People who have OCP and the broader MMP typically experience symptoms in the eye such as burning, light sensitivity, pain, discomfort, itching, blurred vision. These patients may or may not develop adhesions between their eyelid and the white part of their eye, or have changes to the architecture of the eyelids overall.

HOW CAN SPECIALTY CONTACT LENSES HELP?

Those with OCP frequently have corneal irregularity due to the amount of dryness on the surface of the eye. When light hits these areas of irregularity, it spreads out prior to hitting the retina. This results in a poor quality image and difficulty seeing.

 

Specialty contact lenses can help to create a "new" corneal surface that is more regular, allowing light to hit the retina in a straight line.  This results in more defined images on the retina and sharper vision. 

One of the main complaints of people with OCP is that their eyes are very dry and light sensitive, resulting in difficulty managing pain with drops and driving at night. 

Scleral lenses are a type of specialty contact lens that you fill up with a sterile saline solution prior to insertion of the lens into the eye. This saline bathes the eye in saline all day, resulting in decreased dryness.

The longer that you wear these lenses, generally speaking, it gives the cornea time to heal from being so dry and irritated. With time (even months from initially starting lens wear), both dryness and vision improve drastically.

For those with OCP, during the initial onset of this condition, there is a lot of inflammation in the eyes which can result in scarring of the white part of the eye (the bulbar conjunctiva), and the inside of the eyelids (the palpebral conjunctiva). For this reason, sometimes we recommend mold-designed scleral lenses that are able to be designed to incorporate all of these scarred "lumps and bumps" and fit around the eye for more comfort and a better fit. 

After the acute phase of this condition, sometimes we try to have patients fit with scleral lenses sooner rather than later to avoid the formation of adhesions between the lids and the white part of the eye.

The best way to find out if you can benefit from these lenses is to schedule a Specialty Contact Lens Consultation. We will perform a full eye exam along with any testing necessary to suggest the best solutions to your visual issues. 

WHAT PATIENTS ARE SAYING:

"I have dual issues; OCP and exposure keratopathy (eyelids not meeting in the middle) resulting in severely dry eyes.  Neither of these conditions existed prior to plastic surgery which left me with inadequate tissue in both eyelids. Prior to Dr. Morrison fitting me with custom scleral lenses, I was so light-sensitive that the tiny green LED light charging my toothbrush was like a laser beam; I lived in total darkness for 9 months due to pain and light sensitivity. The meibomian oil glands in the eyelids are nonfunctional and may never again produce oil, I've been told. Therefore tears evaporate immediately. I've been wearing scleral lenses for 2 months and am just beginning to get my life back. I feel substantially better when I put the lenses in each morning and it lasts until I remove them 12 hours later. They were comfortable from the first day I started wearing them. I'm grateful to have found Dr. Morrison; she's honest, knowledgeable, and personable; her staff is amazing as well."

- Karen S. 

PATIENT OCP BLOG

One of our patients with OCP was kind enough to put together a list of answers to questions for the benefit of other OCP patients.
 

If you are a current patient with OCP and have anything to add, please contact us.

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Will I be throwing more money at the wall, buying scleral lenses? OCP is an incredibly expensive disease; I still spend $200 a month on over the counter eye drops. However, the lenses have significantly reduced my pain level and light sensitivity. I still cannot golf or hike but at least I'm beginning to regain my freedom; that's priceless.

Will scleral lenses further irritate the bubbles of inflammation I have on my eyelids?

No - it actually helps the inflammation.

How long will it take me to get used to the new lenses?

I remember being uncomfortable for weeks - years ago - adjusting to hard gas permeable lenses. Actually, scleral lenses were very comfortable from the very moment I put them in my eyes. There is a minimal adjustment period with scleral lenses.

How are other OCP patients managing the pain that returns as soon as the lenses are removed?

My pain and light sensitivity is caused by non-functioning meibomian oil glands in the eyelids; my tears evaporate instantly. 

 

Have other OCP patients with severely dry eyes been able to come up with a solution to more easily remove the lenses at the end of the day?

Even though the edges of my lenses have been adjusted several times, at times it still takes multiple tries to remove them. That said, it is definitely worth the effort, not to have level 8 pain all day.