http://informahealthcare.com/cot ISSN: 1556-9527 (print), 1556-9535 (electronic) Cutan Ocul Toxicol, Early Online: 1–2 ! 2014 Informa Healthcare USA, Inc. DOI: 10.3109/15569527.2014.944651

COMMENTARY

Lichen planus on the ocular surface Valentin Huerva

Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by Nyu Medical Center on 07/21/15 For personal use only.

Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain

Lichen planus (LP) is a common skin disease. It is an autoimmune disease of unknown aetiology affecting the skin and mucous membranes. Generally, it affects oral and genital mucosa. LP isolated to the conjunctiva is extremely rare. Conjunctival LP can lead to irreversible damage to the ocular surface. A 54-year-old white woman diagnosed of obstructive sleep apnea syndrome (OSAS) treated with continuous positive airway pressure (CPAP) was reported by stenosis of the inferior lacrimal punctum (Figure 1). The patient referred continuous epiphora that could be attributable to stenosis of the puctum and the nighttime use of the CPAP. However, on slit-lamp examination, symblepharon formation and foreshortening of lower forniceal conjunctiva were identified bilaterally (Figure 1). A conjunctival biopsy specimen was harvested from the symblepharon lesions. The histological analysis was consistent with LP of the conjunctiva (Figure 2).

Keywords Cicatrising conjunctivitis, lacrimal punctum occlusion, lichen planus History Received 14 June 2014 Revised 3 July 2014 Accepted 9 July 2014 Published online 29 July 2014

A systemic examination revealed no lesions on the skin, oral or genital mucosa. Chronic tearing in this case may be attributable to CPAP use and stenosis of the punctum. LP was unsuspectable until that the inferior fornix was examined. LP is a common skin disease. However, LP of the conjuctiva is unusual1. LP is a

Figure 1. Stenosis of the inferior lacrimal punctum (a, superior arrows), symblepharon formation and foreshortening of lower forniceal conjunctiva (b, inferior arrows).

Address for correspondence: Valentin Huerva, Department of Ophthalmology, University Hospital Arnau de Vilanova, Avda. Rovira Roure 80, Lleida 25198, Spain. E-mail: [email protected]

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V. Huerva

Cutan Ocul Toxicol, Early Online: 1–2

exceptional and severe cause of cicatricial conjunctivitis4. Conjunctival LP must be included in the differential diagnosis of cicatrising conjunctivitis as the mucous membrane pemphigoid occurring in the patient needs to be managed properly. Oral cyclosporine can effectively control the conjunctival LP4,5. Stenosis of the lacrimal puctum has been underreported among patients with unknown LP and a conjunctival examination of the fornix should be sought in patients with of the stenosis of the lacrimal duct.

Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by Nyu Medical Center on 07/21/15 For personal use only.

Declaration of interest The author reports no conflict of interest. The author alone is responsible for the content and writing of this article. Figure 2. Hematoxilin–Eosin  40. Hyperkeratosis (A), Acanthosis (B) and an underlying lichenoid infiltrate (C) with a thickened basement membrane (D).

mucocutaneous inflammatory disease that affects multiple sites, including the skin, oral cavity, vulva, and vagina, and can result in scarring and stricture formation. It has also been shown to cause lacrimal canalicular blockage in some patients. The ocular surface inflammation may lead to lacrimal duct stenosis2. LP must also be included in the differential diagnosis of dry-eye disease in patients with chronic watery eye and nonspecific symptoms3. The conjunctival inflammation may occur without involving the skin or another mucosa1. Isolated conjunctival LP may be an

References 1. Pakravan M, Klesert TR, Akpek EK. Isolated lichen planus of the conjunctiva. Br J Ophthalmol 2006;90:1325–1326. 2. Webber NK, Setterfield JF, Lewis FM, Neill SM. Lacrimal canalicular duct scarring in patients with lichen planus. Arch Dermatol 2012;148:224–227. 3. S ¸ anli B, C¸etin EN, Bir F, et al. Conjunctival impression cytology, ocular surface and tear-film changes in patients with lichen planus. Clin Exp Dermatol 2012;37:341–345. 4. Rozas Mun˜oz E, Martı´nez-Escala ME, Juanpere N, et al. Isolated conjunctival lichen planus: a diagnostic challenge. Arch Dermatol 2011;147:465–467. 5. Thorne JE, Jabs DA, Nikolskaia OV, et al. Lichen planus and cicatrizing conjunctivitis: characterization of five cases. Am J Ophthalmol 2003;136:239–243.

Lichen planus on the ocular surface.

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