Conjunctival Scar Excision in Severe Ocular Surface Disease

Abstract

Abstract: : Purpose:To describe a new treatment option for severe ocular surface disease in patients with conjunctival scarring associated with graft–versus–host–disease (GVHD) following hematopoietic stem cell transplantation. Methods:A 50–year–old man with chronic myelogenous leukemia in complete remission, following allogeneic stem cell transplantation, complained of unilateral severe ocular surface pain. Examination revealed extensive corneal punctate staining in a superior and central pattern with conjunctival scarring of the upper eyelid in an area overlying the corneal staining. Conservative treatment with lubrication, topical steroids, punctal plugs, punctal cauterization and a brief trial of topical cyclosporine provided no relief. Placement of a bandage contact lens provided sustained subjective relief with improvement of the corneal surface and vision. He was not, however, able to tolerate the absence of the contact lens for more than an hour. Based on a presumed mechanical etiology of the overlying conjunctival scar causing the corneal surface disease, excision of the scar was offered after informed consent was obtained regarding the risks of operating in the setting of ocular surface disease. The conjunctival scar was excised microsurgically. Post–operatively, a bandage contact lens, topical steroids and antibiotics were used. Results:After healing there was an 80% subjective improvement in symptoms. Examination showed marked reduction of corneal staining and stabilization of his vision. Most importantly, dependency on bandage contact lens wear ended. Conclusions:There may be a mechanical basis for ocular surface disease in the setting of stem cell transplant and GVHD. In patients with severe ocular surface disease and conjunctival scarring, simple scar excision may provide benefit from excision of the scar.

Keywords: conjunctiva • contact lens • cornea: tears/tear film/dry eye