MANAGEMENT OF CONJUNCTIVAL CICATRIZING DISEASES AND SEVERE OCULAR SURFACE DYSFUNCTION

Physical or chemical injuries, infections, immunologic oculocutaneous disorders, drugs, and various systemic disorders may cause scarring of the conjunctiva and disturbances of the ocular surface. Trichiasis, l id margin malposition, and dry eye may result in persistent ocular irr itation. The cornea may be primarily or secondarily involved. If sever e, disturbances of the ocular surface may lead to significant visual i mpairment. Thorough evaluation of patients and of the underlying disea se process is required for optimal management. Treatment may be challe nging and should be comprehensive, combining medical measures and surg ical correction of structural changes. Suppression of exogenous irrita nts, treatment of dry eye, antiinflammatory therapy, and immunosuppres sants are paramount to control the underlying disease and allow optima l surgical results. Surgical correction of trichiasis and lid margin m alposition, conjunctival grafting, mucous membrane transplantation, li mbal stem cell transplantation, amniotic membrane transplantation, and penetrating keratoplasty help reestablish a physiologic ocular surfac e. Severe cases may require keratoprosthetics for visual rehabilitatio n. Corneal ulceration or perforation requires prompt attention to main tain ocular integrity. Special measures should be considered for patie nts who require cataract or glaucoma surgery. (Surv Ophthalmol 43:19-4 6, 1998. (C) 1998 by Elsevier Science Inc. All rights reserved.).