Since 1975, 51 patients (55 eyes) have required corneal surgery for immunologically induced destructive corneal and scleral disease. Lamellar keratoplasty is the preferred surgical procedure provided the cornea is not perforated. Surgery will not be successful unless any underlying systemic disease or active ocular inflammatory disease has been treated previously. Anterior segment fluorescein angiography has been found useful in detecting those patients who might require surgery, in monitoring the effect of medical therapy and in deciding the extent of the surgical procedure. The advantages and limitations of the technique are discussed.