Laser Photocoagulation for Ocular Surface Keratinization: A Minimally Invasive Modality of Treatment

To report 2 cases of lid margin keratinization (LMK) associated with chronic ocular surface inflammation, which were successfully managed using laser photocoagulation.

A case report.

The first case was a 20-year-old man with mycoplasma-induced rash and mucositis. He presented with a focal patch of lid margin keratinization extending to a small area of inferior tarsal conjunctiva in the right lower eyelid, which was causing keratopathy. He underwent laser photocoagulation but experienced a recurrence after 2 months, which was successfully managed with a repeat laser session. At 6 months posttreatment, there were no recurrences, the keratopathy had resolved, and the ocular surface remained stable. The second patient was an 18-year-old woman with Stevens-Johnson syndrome sequelae. She had LMK in all 4 lids and underwent mucous membrane grafting. Postoperatively, she developed focal recurrences of keratinization at the edges of the graft in all 4 lids. The recurrent keratin plaques were treated with laser photocoagulation with a 577-nm laser under local anesthesia. At her last follow-up, 6 months after recurrence, there were no signs of keratinization.

Laser photocoagulation is a safe and effective minimally invasive treatment modality for focal LMK in setting of chronic ocular surface disease. These cases demonstrate its potential as an alternative or adjunct to surgical options like mucous membrane grafting, particularly in a setting of recurrent and localized keratinization.