In this presentation from Cornea Subspecialty Day, Dr. Ed Holland provides a broad overview of limbal stem cell and conjunctival dysfunction. Dr. Holland walks through the clinical findings and pathology, and offers a treatment algorithm for both unilateral and bilateral disease. Most important, he says, is first to recognize the disease when it presents, as many patients with limbal cell failure have chronic, progressive disease that goes undiagnosed for years. As for therapy, routine keratoplasty should not be the mainstay of treatment due to the high failure rate. Dr. Holland urges a team approach to the medical management of ocular disease, especially when treating with immunosuppression.