Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune disorder characterized by blistering and progressive scarring of mucous membranes, including the conjunctiva. As an inflammatory disease, OCP poses a significant risk to the limbal stem cell population, potentially leading to ocular surface instability and visual impairment.

Symptom management in OCP can be challenging due to the chronic, progressive nature of the disease and its impact on the ocular surface. Persistent inflammation, conjunctival scarring, and forniceal shortening can lead to severe dryness, scarring, pain, and vision impairment. Even with systemic immunosuppression, these patients often require a multifaceted approach that includes lubrication, scleral lenses for ocular surface protection, and close monitoring to prevent further damage and manage flare-ups effectively.

A study examined the utilization, benefits, and therapeutic effects of scleral lenses (SLs) in OCP management.¹ A retrospective review evaluated 36 eyes of 20 patients fit with SLs between May 2018 and April 2021. The study examined fitting indications, duration required for ocular surface stabilization, outcomes related to vision rehabilitation, and the incidence of ocular complications.

The average age of participants was 67.4 years (range, 43 to 81 years), with a female-to-male ratio of 4 to 1. The average follow-up duration was 16.5 months, ranging from 1.5 to 35 months. The mean SL wearing time was 9.0 ± 1.9 hours per day for daily wear, without overnight wear. After SL fitting, all patients described a subjective improvement in ocular comfort. The mean keratopathy grading improved from 2.1 ± 0.8 to 1.4 ± 0.7 at the last documented visit.

Mean visual acuity improved from 0.56 ± 0.51 to 0.34 ± 0.45 logMAR, with 46% of eyes gaining 2 or more lines of visual acuity improvement. A total of 96% of fitted eyes responded positively to treatment and continued successful SL wear. Clinical signs, including fornix shortening, symblepharon, and trichiasis, remained stable in patients presenting with these findings at baseline.

The primary goals in managing OCP are to slow or prevent the progression of conjunctival cicatrization, address trichiasis or eyelid abnormalities, and preserve the integrity of the ocular surface. In cases of nonprogressive disease or during periods of disease quiescence, treatment efforts should shift toward ocular surface optimization.

Findings from this study, supported by existing literature, suggest that early intervention with scleral lenses is a safe and effective strategy during periods of disease quiescence and should be strongly considered as an adjunctive therapy in the comprehensive management of OCP.

Reference

1. Severinsky B, Chambers S, Shafi A, Behshad S, Kim J. Scleral lens use in the management of ocular cicatricial pemphigoid. Eye Contact Lens. 2025 Apr 1;51(4):201-205. doi: 10.1097/ICL.0000000000001172

Melissa Barnett, OD, FAAO, FSLS, is the director of optometry at the University of California, Davis. She has received remuneration from ABB, Abbvie, Alcon, Azura, Bausch + Lomb, BCLA, Bruder, Cloudbreak Pharma, CooperVision, Dompé, Epion, JJVC Vistakon, Lentechs, Ocusoft, Orasis, ScienceBased Health, STAPLE Program, Tarsus, and Théa Pharma.

This editorial content was supported via unrestricted sponsorship.