Microsurgical methods of tumor removal have prevailed in the management of ocular surface squamous neoplasia, but over the past decade, use of nonsurgical methods with topical chemotherapy, immunotherapy, antiviral medications, and even photodynamic therapy has increased. In this point-counterpoint presentation from the 2012 Annual Meeting, Dr. Carol Shields presents how the members of her clinical practice use both surgical and nonsurgical methods for OSSN, detailing the indications, benefits, risks, rules, and techniques of surgical therapy and the indications for topical therapy.