When is surgery indicated in the treatment of allergic conjunctivitis?

Updated: Oct 08, 2019
  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Severe cases of corneal shield ulcer may require superficial keratectomy to promote epithelial regeneration. This debridement also serves to obtain a direct culture specimen in the event that secondary infection ensues and helps guide prophylactic topical antimicrobial therapy. Generally, shield ulcers are chronic conditions that are often refractory to conventional therapy. There have been reports of excimer laser phototherapeutic keratectomy (PTK) being used to remove fibrin deposits on the Bowman layer and theoretically facilitate epithelial healing.

Other surgical procedures, such as cryoablation of giant papillae or surgical removal of papillae with mucosal grafting, generally are not required, but they may be helpful in extremely advanced cases. Remember that since VKC is a self-limited disease, extensive reconstructive surgery may not have an acceptable risk-benefit ratio.


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