Conjunctivitis that leads to inflammation and scarring—cicatrizing conjunctivitis (CC)—is rare but can be sight-threatening. CC can lead to persistent ocular discomfort, limbitis, limbal epithelial stem cell deficiency and, ultimately, ocular surface failure with subsequent blinding keratopathy.1 Most cases are accompanied by autoimmune disorders, such as mucous membrane pemphigoid (MMP), atopic keratoconjunctivitis, Sjögren's syndrome, ocular rosacea, Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis.1 Most of the treatment options for these patients include anti-inflammatory or anti-scarring therapies. But gauging the appropriate treatments and developing new options has been a challenge since doctors have no way to identify disease progression or the effects of treatments—until now. Researchers now believe they’ve developed the first validated assessment tool applicable to CC.2
The tool, a fornix depth measurer, is designed to detect conjunctival scaring and monitor the degree of forniceal shortening associated with scarring diseases of the conjunctiva. The investigators say it measures both disease activity and severity and is suitable for clinical and research applications. The device, which is still in the prototype phase, is inserted behind the patient’s lid and into the central fornix. The Ocular Surface has published video of the device in use on its website.
The team tried out the technology on 109 eyes or 55 patients with MMP and 61 eyes of 31 patients with SJS. They tested its use via three methods of validation:
- Comparison of inter-and intra-observer reproducibility.
- Quantitative measurement of the scarring component with a fornix depth measurer compared with qualitative Tauber grading methodology.
- Comparison with the published Sotozono SJS grading system.
The team found the first method’s agreement was moderate-to-excellent for graded components of conjunctival hyperemia, upper and lower symblepharon, upper and lower fornix depth, corneal vascularization and corneal opacity, but was only poor-to-good for limitation of motility, which was rejected from inclusion in the final tool. Comparisons with the Tauber and Sotozono grading methodologies both showed good concordance.2
“The tool is concise and discriminates patients with varying disease severity,” the researchers concluded in their paper.
1. Radford C, Rauz S, Williams G, et al. Incidence, presenting features and diagnosis of cicatrising conjunctivitis in the United Kingdom. Eye (Lond). 2012;26(9):1199–208.
2. Ong H, Minassian D, Rauz S, et al. Validation of a clinical assessment tool for cicatrising conjunctivitis. Ocular Surf. November 3, 2019. [Epub ahead of print].