Cicatrizing Disorders of the Ocular Surface

Ocular surface inflammation severe enough to cause cicatrizing changes in conjunctiva may ensue from a wide variety of pathologies, including noninfectious, infectious, and masquerade-type processes. Eventually uncontrolled disease leads to blindness via secondary corneal ulceration, scarring, and neovascularization. These entities often appear similar in their progression or may even co-exist, making management difficult. Conjunctival biopsy is an important tool in helping the physician to better distinguish between different pathologies. Proper technique and handling are critical to maximizing sensitivity as well as implementation of various means of immunoreactant staining when necessary, i.e., direct immunofluorescence and immunoperoxidase technique. Medical therapy may then be targeted to the specific disease process. Surgical management is reserved for vision rehabilitation and ideally performed when inflammation is in remission.