29
Î Mild and slowly progressive disease may be treated using
mycophenolate mofetil, dapsone, azathioprine, or methotrexate.
(III, I, D)
Î If dapsone is considered, caution should be taken in patients with
glucose-6-phosphate dehydrogenase (G6PD) deficiency. (I-, M, D)
Î For severe inflammation or for inflammation unresponsive to treatment
with other agents, cyclophosphamide should be considered. (III, I, D)
Î These therapies can be used alone or in combination. (III, I, D)
Î A physician with expertise in immunosuppressive therapy should
administer and monitor the treatment to minimize and manage side
effects. (III, G, S)
Î Other less commonly used therapies that may be effective for
treatment or adjunctive therapy include oral tetracycline and
niacinamide. (III, I, D)
Î Other less commonly used therapies that may be effective for
treatment or adjunctive therapy include sulfasalazine. (III, I, D)
Î Other less commonly used therapies that may be effective for
treatment or adjunctive therapy include intravenous immunoglobulin.
(III, I, D)
Î Associated dry eye state, trichiasis, distichiasis, and entropion should
be treated. (III, I, D)
Î Mucous membrane or amniotic membrane grafting for fornix
reconstruction is possible if eyes are not severely dry and
inflammation is under control. (III, I, D)
Î In advanced disease with corneal blindness, keratoprosthesis surgery
may improve vision. (II-, I, D)
Î The timing and frequency of follow-up visits is based on the severity of
disease presentation, etiology, and treatment. (III, I, D)
Î A follow-up visit should include an interval history, visual acuity
measurement, slit-lamp biomicroscopy, and documentation of corneal
and conjunctival changes to monitor progression. (III, I, D)
Î Ocular procedures such as cataract surgery may worsen the disease.
(III, I, D)
Î Perioperative immunosuppression and close postoperative follow-up
are warranted in such cases. (III, I, D)
