Erosive Lichen Planus With Ocular Involvement: A Case Report

BACKGROUND Lichen planus, a chronic autoimmune inflammatory disorder, primarily affects the skin and mucous membranes but may occasionally involve the ocular surface. Ocular manifestations are rare, often underrecognized, and potentially similar to other cicatrizing conjunctivitides. If left untreated, ocular lichen planus may lead to substantial morbidity and permanent visual impairment. Early identification and interdisciplinary management are essential to prevent irreversible damage and systemic complications. Awareness of this entity among ophthalmologists and dermatologists is crucial for timely diagnosis. CASE REPORT A 69-year-old woman developed chronic conjunctivitis and visual decline 3 months after bilateral uncomplicated cataract surgery. Ocular findings included conjunctival hyperemia, punctate keratitis, and meibomian gland dysfunction. Systemic evaluation revealed oral ulcers, violaceous skin plaques, onychodystrophy, and dysphagia. Oral biopsy confirmed lichenoid mucositis, and nail biopsy supported a diagnosis of systemic erosive lichen planus (ELP). Both direct and indirect immunofluorescence findings were negative; hepatitis C and autoimmune serologies were unremarkable. A multidisciplinary team established the diagnosis of ELP with ocular involvement. The patient received azathioprine (100 mg/day) and a short course of oral corticosteroids, which resulted in substantial improvement of ocular inflammation, mucocutaneous lesions, and visual acuity within 4 months. Sustained remission was evident after 1 year of follow-up. CONCLUSIONS This case underscores the importance of considering ELP in patients who present with chronic ocular surface inflammation and concomitant mucocutaneous lesions. Ophthalmologists play a key role in recognizing systemic inflammatory disorders and coordinating interdisciplinary care. Prompt diagnosis, long-term follow-up, and systemic immunosuppressive therapy are vital to prevent scarring and permanent sequelae.