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Isolated lichen planus of the conjunctiva
  1. M Pakravan,
  2. T R Klesert,
  3. E K Akpek
  1. The Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
  1. Correspondence to: Esen Karamursel Akpek MD, Director, Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, 600 North Wolfe Street, Maumenee Building No 321, Baltimore, MD 21287-9238, USA; esakpek{at}jhmi.edu

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Lichen planus is an autoimmune condition of unknown aetiology affecting the skin and mucous membranes. Classic lesions appear as recurrent, small, discrete, polygonal, flat topped, violaceous, pruritic papules distributed symmetrically on the flexor surfaces of the extremities and trunk. These lesions are often accompanied by lesions of the oral, genital, and rarely, ocular mucosa. Conjunctival lichen planus can lead to irreversible damage to the ocular surface and loss of vision from corneal scarring.1,2 We report two patients with isolated lichen planus of the conjunctiva. The referring ophthalmologists had attributed these ocular findings to a severe dry eye state. The correct diagnosis was made by conjunctival biopsy. Treatment with topical ciclosporin A resulted in suppression of the inflammation and arrest of the progressive cicatrisation.

Case 1

A 57 year old white woman with a diagnosis of secondary Sjögren’s syndrome was referred for further management of severe keratoconjunctivitis sicca, which had been refractory to treatment with multiple topical medications, including topical steroids, as well as punctal plugs. The patient had a history of rheumatoid arthritis with crippling deformities in her hands.

On examination, slit lamp biomicroscopy revealed inadequate …

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