Background: Lichen planus is a common inflammatory autoimmune condition of unknown etiology that commonly affects the skin and mucous membranes. Isolated ocular lichen planus is an extremely rare presentation that most commonly involves the eyelids, conjunctiva, and cornea, leading to severe scarring, and is clinically indistinguishable from other causes of cicatricial conjunctivitis.Observations: A 79-year-old man complained of a chronic keratoconjunctivitis refractory to multiple topical treatments. Slit-lamp examination revealed diffuse bilateral conjunctival hyperemia, subepithelial fibrosis, and symblepharon, with a marked shortening of the lower conjunctival fornix. There were no other skin or mucosal lesions. Hematoxylin-eosin staining revealed acanthosis, focal thickening of the basement membrane, and a dense subepithelial mononuclear infiltrate. Direct im-

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