This guideline last updated 06/05/2022 17:48:06

Differential diagnosis

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