Autoimmune Blepharitis

Autoimmune diseases result from disorders of the immune system in which, instead of protecting the body, the immune response attacks the body's own cells and tissues. A significant number of autoimmune diseases are clinically manifested by changes of the eyelids.

Pemphigus foliaceus is an immune-mediated disease in which autoantibodies are directed against the intercellular matrix of the epidermis. The primary lesion is a superficial pustule that ruptures easily; therefore, erosions, scales, yellow crusts, alopecia, hypopigmentation, and ulcerations are most commonly observed. Lesions begin on the bridge of the nose, around the eyes, and on the pinnae, and become generalized as the disease progresses. The disease generally affects middle-aged animals, with Akitas, Chow Chows, and Labrador Retrievers predisposed.

Lupus erythematosus may be systemic, involving the skin, kidneys, and joints, or discoid, with lesions limited to the skin. Initial lesions occur on the nasal planum and subsequently on the eyelids, particularly at mucocutaneous junctions. Nasal depigmentation is present, and the skin may show erosions, erythema, scaling and/or crusting, and ulceration. Collies, Shetland Sheepdogs, and German Shepherd Dogs are most commonly affected.

Uveodermatologic syndrome develops when autoimmune processes are directed against melanocytes of the uvea and skin. Clinical signs include loss of pigment from the nasal planum and eyelids, together with sudden vision loss or, in milder cases, marked reduction in vision. Akitas, Chow Chows, and Siberian Huskies are most commonly affected.

Autoimmune blepharitis of the medial canthus in dogs is most commonly bilateral and occurs in German Shepherd Dogs, long-haired Dachshunds, and Poodles.

Treatment

A reliable diagnosis is established by biopsy of affected tissue with histopathologic examination, together with detection of autoantibodies in the blood. Treatment is prolonged and includes corticosteroids and other immunosuppressive medications. The dose is determined individually and adjusted according to the clinical presentation.

Pemphigus foliaceus. Alopecia, erythema, erosions, and crusts on the bridge of the nose and around the eyes. As a result of eyelid inflammation, a corneal ulcer developed in the right eye.

Pemphigus foliaceus. Alopecia, erosions, and crusts on the bridge of the nose and around the eyes.

Discoid lupus erythematosus. Erosions and crusts on the nasal planum, bridge of the nose, and around the eyes.

Uveodermatologic syndrome. Depigmentation of the hair on the muzzle and periocular region with uveitis and chorioretinitis in this patient.

Autoimmune blepharitis of the medial canthus in a dog.

Autoimmune blepharitis of the medial canthus in a dog, advanced case.

Autoimmune blepharitis of the medial canthus in a dog.

Autoimmune blepharitis in a dog.

Autoimmune blepharitis of the medial canthus in a dog.

Adapted from the Atlas of Ocular Diseases in Dogs and Cats by Dr. Siniša D. Grozdanić and colleagues. © Animal Eye Consultants of Iowa. The text and clinical images on this page are original content from the authors' own clinical practice and research, and may not be reproduced, distributed, or repurposed without permission.

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