Pemphigus, an autoimmune disorder that affects the mucous membranes and the skin, has previously been thought to influence the ocular surface in many ways, mainly through chronic conjunctivitis. A new study widens this condition’s influence on the eye by suggesting it may also be associated with dry eye and meibomian gland structural changes.

The study, published in Cornea, included 20 eyes of 20 patients with pemphigus and 20 eyes of 20 age- and sex-matched healthy volunteers. The  investigators evaluated dry eye with Oxford scale scoring, tear film break-up time, Schirmer 1 tests and Ocular Surface Disease Index (OSDI) score assessments. They also used meibography to look for structural changes and the meibomian gland dropout ratio. The study scored the meibomian gland dropout ratio for each eyelid from grade zero (no loss) through grade three (loss area greater than two-thirds of the total meibomian gland area).

In the pemphigus group, Schirmer 1 and tear film break-up time results were significantly lower and Oxford and OSDI scores significantly higher than the healthy eyes.  Also, upper and lower eyelids and total eyelid meibomium score values were significantly higher in the pemphigus patients. 

Researchers found meibomian gland structural changes in 80% of patients in the pemphigus group.

Patients with pemphigus should be monitored for dry eye and meibomian gland dysfunction and be promptly treated to prevent the serious consequences of dry eye, the study authors noted in their paper.

Kiyat P, Palamar M, Turk  BG, Yagci A. Dry eye and quantitative and qualitative changes of meibomian glands in patients with pemphigus. Cornea. Mar 29, 2020. [Epub ahead of print].