Changing concepts in the management of severe ocular surface disease over twenty-five years

The management of severe ocular surface disease (OSD) has changed dramatically over the last 25 years. In the 1970s, all patients with severe OSD had a poor prognosis. The available techniques for visual rehabilitation at that time consisted of lamellar and penetrating keratoplasty, tarsorrhaphy, and preserved artificial tears. Modern day treatment of severe OSD is quite different. Advances in microsurgical techniques and understanding of the role of the limbal stem cells have led to great improvements in both visual acuity and quality of life for these patients. Progress in this area has occurred in a step-wise fashion. What follows is a chronological review of what we believe are the most important steps that have brought us to where we are today in the treatment of seven OSD.