Medical and surgical approach to ocular surface reconstruction

: Ocular surface disease (OSD) can have a severe impact on patients as it can lead to visual impairment and persistent discomfort. Ocular surface reconstruction (OSR) is an approach to the management of ocular diseases that cause structural damage to the ocular surface. OSR encompasses both medical and surgical treatment options. In this review, we discuss the medical and surgical strategies used in OSR. Medical management often aims to treat tear insufficiency, inflammation, and keratinization. Surgical treatments may be employed for a variety of reasons, including failure of medical management. This may include improving the oculo-palpebral structures in order to improve lid positioning and tear film. Additional therapies focus on improving tear production, such as through salivary gland transplantation. In situations where the ocular surface is so severely damaged that there is loss of limbal stem cells, limbal stem cell transplant (LSCT) may be indicated. Other surgeries such as amniotic membrane transplant (AMT) and conjunctival flaps (CFs) can help promote corneal healing. Finally, in severe situations where the cornea is beyond salvage, corneal transplantation, such as a penetrating keratoplasty (PK), can be considered. OSR often requires a combination of medical and surgical approaches targeted to each specific patient's presentation in order to achieve optimal outcomes.