Autoimmune phenomena of the conjunctiva and cornea. A case report

B. J. Mondino, S. I. Brown, B. S. Rabin and M. A. Lemp

A 20-year-old woman had erosions of the corneal and conjunctival epithelium and sterile stromal ulcerations of the cornea necessitating multiple corneal grafts, which were unsuccessful. An immunopathological basis for her disease was suggested by the demonstration of tissue-fixed antibodies and complement in her own conjunctival epithelium by direct immunofluorescence. In addition, circulating antibodies to normal corneal and conjunctival epithelium were demonstrated in the patient's serum by indirect immunofluorescent techniques and the titer of circulating antibodies was found to correlate with disease activity. The involvement of the fellow eye after evisceration of the first eye and reduction of systemic steroids in association with a greatly elevated level of circulating antibodies provided additional evidence for an autoimmune process. A background of immunological susceptibility was found in the patient and her family by history and immunological examination.