PMC9121463_01
A Slit-Lamp photo showing the remaining conjunctival adhesions after conjunctival
biopsy.
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Notably there was symblepharon in each eye (Figure 1) involving the inferior bulbar and palpebral conjunctiva involving up to 3 clock hours, and associated with cicatrization of the caruncle.
(A) Conjunctival biopsy: Patchy chronic stromal inflammation with focal interface
inflammation. No intra epithelial or full thickness bullae. Squamous metaplasia of the
epithelium with loss of goblet cells. Histological features are not suggestive of
blistering disorders. Focal interface inflammation may be associated lichen planus.
(Hematoxylin and Eosin, 4x). (B) Conjunctiva: Lymphocytic inflammation without
eosinophils or mast cells. Stromal fibrosis, bands of collagen instead of normal loose
conjunctival stroma. (Hematoxylin and Eosin, 40x). (C, E, G, and I) Immunohistochemistry
stains with IgG, IgA, IgM, and C3 respectively. There is no linear basement membrane
staining of IgG (C), IgA (E), IgM (G), and C3 (I). There is patchy intercellular
staining of IgG (C). No intracellular staining is seen. (D, F, H, J, and K)
Immunofluorescence stains with IgG, IgA, IgM, C3, and Fibrinogen respectively. There is
no linear basement membrane staining of IgG (D), IgA (F), IgM (H), C3 (J), and
Fibrinogen (K). There is patchy intercellular staining of IgG (D). No intracellular
staining is seen. This staining profile excludes ocular cicatricial pemphigoid and other
blistering conditions such as pemphigus. The lack of linear and thickened basement
membrane immunofluorescence with fibrinogen excludes lichen planus.
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The histology section showed patchy chronic stromal inflammation with focal interface inflammation (Figure 2A and B). Features suggestive of allergic conjunctivitis such as mast cells and eosinophils were not observed (Figure 2B). There were no features of ocular cicatricial pemphigoid on the immunofluorescence or immunohistochemistry findings (Figure 2C-K). Linear deposits of IgA, IgM, C3, and fibrinogen were not seen in the sub-epithelial basement membrane zone (Figure 2C-K). Although intercellular staining may be present in pemphigus disease of the skin, this staining in the conjunctiva is non-specific and not diagnostic of pemphigus (Figure 2C and D) without relevant clinical correlation.