Lichen Planus in Ocular Surface: Major Presentations and Treatments

Ocular lichen planus (LP) is a rare disease which has been increasingly reported in the literature in the last two decades involving conjunctiva, cornea, and lacrimal drainage system. Most reported cases of ocular LP are cicatricial conjunctivitis with subepithelial fibrosis, fornix shortening, and symblepharon formation. It is not clear whether corneal involvement is a primary event or secondary to these changes. Topical cyclosporine and corticosteroid can be considered as first-line therapy in ocular surface involvement, while treatment regimen in more aggravated disease should be boosted with systemic immunosuppressives. After resolving acute inflammation, the patient should be treated with long-term maintenance therapy to halt the chronic progression of the disease. Lacrimal drainage system could also be involved, usually in a bilateral bicanalicular pattern with severe punctal/canalicular stenosis. Because of severity, the surgical outcomes are not favorable but successive treatments with dacryocystorhinostomy + mitomycin C (MMC), Jones tube implantation, and systemic cyclosporine are reported.