Dr. Foster said that the case with the woman from India points out some key pearls when immunomodulator therapy is necessary in a patient with ocular surface disease. Clinicians should know the systemic diagnosis well or at least understand its general mechanism, harvest tissue whenever possible, and do what is needed to stop the inflammation.
In some of these patients, diagnosis and treatment may help save the patient’s life and/or vision, he said.
Another cause of red eye seen occasionally is ocular cicatricial pemphigoid (OCP).
“All treatments except those which suppress abnormal immune responses have failed to stop the progressive conjunctival scarring characteristic of OCP,” Dr. Foster said.
For progressive disease with mild to moderate inflammation, Dr. Foster recommends methotrexate, azathioprine (Imuran, Prometheus), or mycophenolate mofetil (CellCept, Genentech) initially. For marked inflammation, he recommends cyclophosphamide with prednisone, cytosine arabinoside, or IVIg/rituximab.