Date of last review: Due to be updated

Differential diagnosis

  • Cicatrising conjunctivitis
    • Ocular Cicatricial Pemphigoid
    • Stevens-Johnson Syndrome
    • Graft vs host disease
    • Trachoma
  • Trauma (surgery, thermal, radiation, mechanical, chemical)
  • Atopic keratoconjunctivitis
  • Vernal keratoconjunctivitis
  • Ligneous conjunctivitis

Possible management by Optometrist

Treatment

  • Ocular lubricants for tear deficiency/instability related symptoms (drops for use during the day, unmedicated ointment for use at bedtime)
  • Scleral therapeutic contact lens
    • to prevent desiccation by maintaining a fluid layer beneath the lens
    • to prevent trauma from keratinised lids

Advice

  • Some forms of conjunctival scarring can lead to severe exposure keratopathy and loss of vision. These forms are usually autoimmune in nature and require immunosuppression to prevent progression
  • Other forms are relatively mild and require observation but not direct intervention

Management Category                                               

  • Normally no referral for mild scarring resulting from minor trauma or surgery
  • Urgent referral (within one week) if cicatrising conjunctivitis disease is suspected

Possible management by Ophthalmologist

  • Topical and/or systemic immunosuppression if autoimmune aetiology
  • Mucous membrane graft
  • Amniotic membrane transplantation