Conjunctival Biopsy in Ocular Mucous Membrane Pemphigoid

OBJECTIVE: Ocular mucous membrane pemphigoid (oMMP) is a chronic autoimmune disorder that manifests primarily as progressive conjunctival scarring. We reviewed the published literature on the role of conjunctival biopsy in oMMP. DESIGN: Perspective. METHODS: Review of literature. RESULTS: The disease can result in progressive ocular surface discomfort, conjunctival scarring, and potential vision loss if timely systemic immunosuppression is not initiated. The diagnosis is typically contingent on positive findings on direct immunofluorescence of conjunctival biopsy samples. This is affected by several factors, which include but are not limited to the site of biopsy, stage of disease, tissue size, and expertise of the interpreting pathologist. Relying solely on the outcome of conjunctival biopsy can delay the institution of the required treatment, and this can adversely affect visual function and clinical outcome. When a thorough history and clinical examination effectively exclude common mimickers of oMMP, the observation of progressive conjunctival cicatrization in the absence of features suggestive of alternative etiologies may be sufficient to establish the diagnosis and mandate timely clinical management. In this context, conjunctival biopsy can be reserved for cases with atypical presentations or when differentiation from other entities, such as drug-induced cicatrization, is required. CONCLUSIONS: This perspective highlights the practical considerations, limitations, and evolving role of conjunctival biopsy in oMMP, underscoring its selective role within a multidisciplinary approach to the diagnosis and management of cicatricial conjunctivitis.