3.12 Scarring, Conjunctival

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.12 Scarring, Conjunctival

Date of last review:

29/4/2026

Date of next review:

29/4/2028

Date of publication:

6/7/2026

Differential Diagnosis ⁽¹⁾

A thorough ophthalmic and medical history usually reveals the cause of conjunctival scarring
If no cause is apparent, exclude early Ocular Cicatricial Pemphigoid (OCP)

Possible management by optometrist

Advice ⁽¹⁾

Assess for dry eye indicators, including:

Reduced tear meniscus
Low tear film break up time
Fluorescein staining of the inferior cornea and interpalpebral conjunctiva

Check for signs of mechanical trauma, such as:

Trichiasis
Keratinised tarsal conjunctiva

Management options include:

Taping to temporarily reduce entropion
Night‑time lid taping in lagophthalmos
Therapeutic contact lenses—preferably scleral lenses when the eye is significantly dry, to:
- Maintain a protective fluid reservoir
- Prevent trauma from keratinised conjunctiva
- Assist healing of epithelial defects

Treatment

Ocular lubricants for tear deficiency/instability related symptoms (drops for use during the day, unmedicated ointment for use at bedtime)⁽¹⁾. Refer to local formularies for suitable options ⁽⁶⁾

NB. Patients with long-term topical medication use may develop sensitivity to preservatives or active ingredients — switch to unpreserved preparations where appropriate ⁽¹⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

As required (see ‘Treatment’ above)

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options ⁽¹⁾

Mild Scarring (e.g. due to minor trauma or surgery)

Alleviation / palliation only
No referral normally required

Moderate–Severe Scarring

Begin initial management (including lubricants), then routine referral.
Any scarring of unknown cause must be referred for further investigation.

Urgent Referral

If autoimmune ocular disease (e.g. OCP) is suspected, refer urgently.

Possible management in secondary care or local/community pathways where available ⁽¹⁾

Depending on the underlying cause and severity, secondary care may consider:

Topical or systemic immunosuppression for autoimmune aetiology
Conjunctival or buccal mucous membrane grafts
Stem cell transplantation
Amniotic membrane transplantation
Lid surgery (used cautiously in OCP as surgery may trigger further inflammation and scarring)

College of Optometrists Clinical Management Guideline⁽¹⁾ 

Conjunctival scarring - College of Optometrists *

* With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

Disclaimers

CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation, and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways.

Users should note that Guidelines which have not yet been updated should be considered with caution. Where the Eyecare Guidelines contain links to other sites and/or resources provided by third parties, these links are provided for information only.

Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines are made available on the basis of excluding all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Eyecare Guidelines.

CEG disclaimer for updated guidelines:

Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

Updating the Eyecare Guidelines requires a continuous process; the date of the last review for each guideline will be clearly noted on each guideline. Users must consider these dates before using the guidance.

While the Common Services Agency (“PSD Scotland”) makes reasonable efforts to ensure that the information on the Eyecare Guidelines area of the Website is correct, the Website is provided ‘as is’ and PSD Scotland does not warrant the accuracy and completeness of the material on the Website. PSD Scotland may make changes to the Website at any time without notice. Some of the material on the Website may be out of date, and PSD Scotland makes no commitment to update such material. Users should note that some Eyecare Guidelines on the Website have not been updated for several years and should be considered with caution.

Where the Eyecare Guidelines section of the Website contains links to other sites and or resources provided by third parties, these links are provided for information only. PSD Scotland has no control over, and no liability in respect of, the content of these sites and resources.

Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines area of the Website is made available by PSD Scotland on the basis that PSD Scotland excludes all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Website. 