To highlight a case of paraneoplastic mucous membrane pemphigoid secondary to neuroendocrine tumour presenting with cicatricial entropion.

An 83 year old gentleman presented with red eye, corneal ulcer, cicatricial entropion of right upper and lower lid with symblepharon and subconjunctival scarring. He had associated painful mouth ulcers and loss of weight. He was treated for oesophageal cancer ten years back. He underwent a right upper lid and lower lid entropion correction, sequential conjunctival biopsies from each eye and a buccal mucosal biopsy.

Immunohistochemistry of conjunctival biopsy from the fellow, less inflamed eye was positive with linear IgG present at the basement membrane zone. There was no evidence of IgA or C3. Histology suggested a possible paraneoplastic phenomenon. Buccal mucosal biopsy was negative. Based on histology, patient underwent further imaging by the oncologist which revealed a liver lesion confirmed to be a metastatic neuroendocrine tumour on liver biopsy unrelated to oesophageal carcinoma. Para-aortic and pelvic lymph nodes were also involved as well as bony metastasis. The primary site is uncertain.

Paraneoplastic conjunctival cicatrisation is rare and has been previously reported with haematological malignancies and bronchogenic carcinoma. To our knowledge this has not been reported so far secondary to a neuroendocrine tumour. A past history of cancer should always be sought in patients with features of mucous membrane pemphigoid.