Mucous membrane pemphigoid (MMP) is the terminology used to describe a group of chronic subepithelial inflammatory disorders that cause both inflammation and progressive cicatrization of mucosal membranes and skin. Of greatest interest to the ophthalmologist, MMP may affect the ocular mucosa, which if left untreated is often sight threatening. However, MMP also affects the oral, anal, genital, nasopharyngeal, esophageal, and laryngeal mucosa, as well as skin, resulting in multisystem disease including life-threatening airway obstruction. Caring for patients with ocular MMP can be a frustrating experience, and not simply because this disease can be hard to manage. Delays in diagnosis are common; accurately documenting progression can be difficult; delineating active MMP from secondary ocular inflammation due to dryness, keratinization, trichiasis, and bacterial colonization is a challenge; and obtaining authorization for treatment medications, especially when there is only ocular involvement, is an ongoing battle.