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Ocular Surface Reconstruction

Multimodal restoration of corneal and conjunctival surface in severe disease

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Ocular Surface Reconstruction?

Ocular surface reconstruction is the staged management of severe surface disease combining medical optimization, anti-inflammatory and immunosuppressive therapy, surgical components (amniotic membrane transplantation, mucous membrane grafting, conjunctival autografts, limbal stem cell transplantation), keratoprosthesis, and lifelong rehabilitation. The goals are to restore a stable epithelium, eliminate inflammation, reconstruct fornix anatomy, and maximize visual function.

Causes of severe surface disease include chemical and thermal burns, Stevens-Johnson syndrome and toxic epidermal necrolysis, ocular cicatricial pemphigoid, severe atopic and vernal keratoconjunctivitis, mucous membrane pemphigoid, post-radiation, post-surgical (multiple keratoplasties, mitomycin-C exposure), aniridia, ectodermal dysplasia, and severe dry eye.

A staged approach typically begins with medical optimization (lubrication, autologous serum, scleral lenses, anti-inflammatory drops, systemic immunosuppression), proceeds to surgical reconstruction (amniotic membrane transplantation for persistent epithelial defects, symblepharon release with mucous membrane grafts, limbal stem cell transplantation, fornix reconstruction with mucous membrane), and concludes with visual rehabilitation (penetrating keratoplasty after stable surface, keratoprosthesis for end-stage disease). Multidisciplinary care is essential.

Symptoms

Persistent corneal epithelial defects
Recurrent corneal erosions
Conjunctivalization of cornea
Corneal neovascularization, scarring
Symblepharon (conjunctiva-conjunctiva or conjunctiva-cornea adhesions)
Ankyloblepharon (lid fusion)
Trichiasis (lashes against cornea)
Entropion, ectropion, lagophthalmos
Severe dry eye, mucous discharge
Photophobia, pain, foreign body sensation
Vision loss
Bilateral involvement (severe forms)
Limbal stem cell deficiency
Failed prior keratoplasty
Forniceal foreshortening
Punctal stenosis or destruction
Lid abnormalities compounding disease
Vascularized cornea precluding standard transplantation
Active inflammation despite topical therapy
Ocular discomfort severely impairing quality of life

Risk Factors

Chemical burns (alkali highest risk)
Thermal burns
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Ocular cicatricial pemphigoid
Mucous membrane pemphigoid
Severe atopic keratoconjunctivitis
Vernal keratoconjunctivitis
Aniridia
Severe dry eye (Sjögren syndrome)
Ectodermal dysplasia
Mitomycin-C exposure
Multiple ocular surgeries
Radiation therapy
Lid abnormalities
Trichiasis from lid disease
Severe blepharitis
Contact lens overuse
Diabetes mellitus (delayed healing)
Vitamin A deficiency

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe ocular surface burn requiring urgent care
  • Persistent epithelial defect not responding to therapy
  • Severe Stevens-Johnson syndrome with ocular involvement
  • Ocular cicatricial pemphigoid
  • Severe atopic keratoconjunctivitis with corneal damage
  • Aniridic keratopathy
  • Symblepharon developing
  • Trichiasis or lid abnormalities causing surface damage
  • Failed prior keratoplasty
  • Severe dry eye unresponsive to standard therapy
  • Multidisciplinary care need
  • Considering staged surgical approach
  • Quality-of-life impairment from surface disease

Treatment Methods

01
Comprehensive evaluation by cornea and ocular surface specialist
02
Determination of underlying disease and systemic implications
03
Treatment of underlying systemic disease (immunosuppression for cicatricial pemphigoid: cyclophosphamide, mycophenolate, rituximab, IVIG)
04
Anti-inflammatory therapy with topical corticosteroids and cyclosporine 0.05-2%
05
Lifitegrast for inflammatory dry eye
06
Lubrication with preservative-free artificial tears, autologous serum, plasma rich in growth factors
07
Scleral contact lenses (PROSE, EyePrint Pro) for advanced disease
08
Punctal occlusion
09
Lid disease management (lid hygiene, intense pulsed light, meibomian gland expression)
10
Treatment of trichiasis (epilation, electrolysis, cryotherapy, lid surgery)
11
Amniotic membrane transplantation for persistent epithelial defects
12
Mucous membrane grafting (oral or labial mucosa) for fornix reconstruction
13
Conjunctival limbal autograft (CLAU) from contralateral healthy eye
14
Simple limbal epithelial transplantation (SLET)
15
Cultivated limbal epithelial transplantation (CLET) or Holoclar
16
Living-related conjunctival limbal allograft (LR-CLAL) for bilateral disease
17
Cadaveric keratolimbal allograft (KLAL)
18
Cultivated oral mucosal epithelial transplantation (COMET)
19
Symblepharon release
20
Fornix reconstruction with conjunctival or mucous membrane grafts
21
Tarsorrhaphy for severe lagophthalmos or persistent epithelial defects
22
Penetrating keratoplasty after stable surface (typically 6-12 months after limbal reconstruction)
23
Deep anterior lamellar keratoplasty (DALK)
24
Endothelial keratoplasty (DSEK, DMEK) for endothelial dysfunction in stable surface
25
Boston keratoprosthesis Type 1 or Type 2 for end-stage disease
26
Osteo-odonto-keratoprosthesis (OOKP) for severe Stevens-Johnson syndrome
27
Glaucoma management often required
28
Long-term immunosuppression for allogeneic transplants
29
Lifelong follow-up with frequent slit-lamp examinations
30
Multidisciplinary care including cornea specialists, oculoplastic surgeons, immunology, dermatology, rheumatology

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.