Conjunctival scarring after eyelid surgery as first sign of ocular cicatricial pemphigoid.

Diagnosis of ocular cicatricial pemphigoid (OCP), a chronic cicatrizing autoimmune disease of the conjunctiva, may be difficult in the early stages of the disease. We noted abnormal conjunctival scarring in three patients who had undergone eyelid and strabismus surgery, which caused us to suspect OCP. In all three patients who subsequently underwent conjunctival biopsy, immunoglobulin or complement in the basement membrane zone detected by direct immunofluorescence helped establish the diagnosis.