BENIGN MUCOUS MEMBRANE PEMPHIGOID 1. Secretion of mucus and tears

Benign mucous membrane pemphigoid (BMMP) is differentiated from other bullous diseases of the skin and mucous membranes. The affection is further described clinically, histologically and immunologically. Twenty-nine eyes affected with BMMP were subjected to quantitative measurements of the tear secretion by the tear dilution test and of the conjunctival mucus secretion by measuring the vital-stained mucous thread. Both secretions were found to be significantly reduced in about two-thirds of the eyes (18 and 19 eyes, respectively). A normal tear secretion and a normal mucus secretion were combined in no more than four eyes. Secondary rudimentary or absent Marx' line was noticed in nine eyes with reduced tear secretion. Epithelial cell degeneration of the tarsal conjunctiva, demonstrated by vital staining with rose bengal (14 eyes) or iodonitrotetrazolium (15 eyes) was presumably secondary to reduced secretion of both tears and mucus. Leucoplakia of the tarsal conjunctiva was seen in 13 eyes, all with a reduced production of mucus. Ordinary slit lamp examination showed eight corneae to be affected (maculae, blood-vessel invasion, dermatoid conjunctival invasion). However, examinations comprising wetting-time, Schweitzer's polygonal pattern and vital staining yielded one or more abnormal tests in all the eyes, suggesting that the cornea or at least the precorneal film is pathological in all cases of BMMP.