Dart, JK;
(2017)
The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on.
Eye
, 31
pp. 301-332.
10.1038/eye.2016.284.
Preview |
Text
25261_0_merged_1478463303.pdf - Accepted Version Download (29MB) | Preview |
Abstract
This review is in two sections. The first section summarises 35 conditions, both common and infrequent, causing cicatrising conjunctivitis. Guidelines for making a diagnosis are given together with the use of diagnostic tests, including direct and indirect immunofluorescence, and their interpretation. The second section evaluates our knowledge of ocular mucous membrane pemphigoid, which is the commonest cause of cicatrizing conjunctivitis in most developed countries. The clinical characteristics, demographics, and clinical signs of the disease are described. This is followed by a review and re-evaluation of the pathogenesis of conjunctival inflammation in mucous membrane pemphigoid (MMP), resulting in a revised hypothesis of the autoimmune mechanisms causing inflammation in ocular MMP. The relationship between inflammation and scarring in MMP conjunctiva is described. Recent research, describing the role of aldehyde dehydrogenase (ALDH) and retinoic acid (RA) in both the initiation and perpetuation of profibrotic activity in MMP conjunctival fibroblasts is summarised and the potential for antifibrotic therapy, using ALDH inhibition, is discussed. The importance of the management of the ocular surface in MMP is briefly summarised. This is followed with the rationale for the use of systemic immunomodulatory therapy, currently the standard of care for patients with active ocular MMP. The evidence for the use of these drugs is summarised and guidelines given for their use. Finally, the areas for research and innovation in the next decade are reviewed including the need for better diagnostics, markers of disease activity, and the potential for biological and topical therapies for both inflammation and scarring.
Type: | Article |
---|---|
Title: | The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on. |
Location: | England |
Open access status: | An open access version is available from UCL Discovery |
DOI: | 10.1038/eye.2016.284 |
Publisher version: | http://dx.doi.org/10.1038/eye.2016.284 |
Language: | English |
Additional information: | Copyright © 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. The final publication is available at [Journal title] via http://dx.doi.org/10.1038/eye.2016.284. |
UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology |
URI: | https://discovery.ucl.ac.uk/id/eprint/1537679 |
Archive Staff Only
View Item |