Rare Eye Complication of Lichen Planus Raises Vision Loss Risk: Case Report

The case, published in the Journal of the Pakistan Medical Association, describes keratoconjunctivitis with corneal ulceration in a woman with widespread erosive

lichen planus, a manifestation that can threaten vision if diagnosis or treatment is delayed.

Lichen planus is an immune-mediated inflammatory disorder that commonly affects the skin and oral mucosa, producing characteristic itchy, violaceous lesions. While most cases are limited to cutaneous or oral involvement, erosive lichen planus represents a much less common and more debilitating variant. This form is marked by painful erosions of the oral cavity and soles, often causing significant functional impairment. Ocular involvement is exceedingly uncommon and therefore easily overlooked, yet it may lead to permanent visual damage.

The authors reported the case of a 36-year-old woman who presented to the Dermatology Department at Mayo Hospital, Lahore, with an eight-month history of widespread pruritic skin lesions and severely painful erosions on her hands and feet. The erosive disease had progressed to the extent that she experienced loss of toenails and dystrophic changes in fingernails. She also reported painful erosions in the oral and genital mucosa, significantly affecting her quality of life.

Three months before presentation, the patient developed eye-related symptoms, including photophobia, ocular pain, excessive tearing, and progressive reduction in vision in both eyes. Dermatological examination revealed symmetrically distributed violaceous papules and plaques over the trunk and extremities, along with deep erosions on the soles, ankles, and fingertips. Ophthalmic assessment showed marked conjunctival inflammation, watery discharge, and severe photophobia, with vision reduced to light perception. Further evaluation confirmed bilateral keratoconjunctivitis with corneal ulceration.

Histopathological examination of a skin biopsy demonstrated classic features of lichen planus, including saw-toothed acanthosis, basal cell degeneration, and a dense lymphocytic infiltrate at the dermoepidermal junction. Direct immunofluorescence supported the diagnosis, while extensive laboratory work-up ruled out viral infections, autoimmune disease, and metabolic abnormalities.

The patient was initially treated with high-dose systemic corticosteroids, along with supportive ophthalmic care including lubricants and topical antibiotics. Although some improvement was seen in ocular inflammation, her skin and mucosal lesions responded poorly. Azathioprine was subsequently introduced, leading to significant healing of cutaneous erosions over six weeks, while oral lesions improved more gradually. The corneal ulcers also showed signs of re-epithelialization, though residual scarring remained, and keratoplasty is being considered as part of long-term management.

In their discussion, the authors emphasize that ocular involvement in lichen planus is rare but potentially devastating. Because ocular signs are often nonspecific, the presence of typical skin and oral lesions plays a crucial role in establishing the diagnosis. They stress that multidisciplinary collaboration between dermatologists and ophthalmologists is essential for optimal outcomes.

The case highlights the importance of prompt diagnosis, aggressive treatment, and long-term follow-up in erosive lichen planus. Early recognition of ocular involvement, the authors conclude, is critical to preventing irreversible vision loss and reducing disease-related morbidity.

Reference:

Arooba, Zahra, et al. "Keratoconjunctivitis and Corneal Ulceration in a Patient With Erosive Lichen Planus." JPMA. the Journal of the Pakistan Medical Association, vol. 75, no. 12, 2025, pp. 1954-1956.