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We are grateful for the interest shown by Dr Shoaib in our study. 1 In our series, none of the cases had been treated with steroids—appropriately or otherwise—before seeking treatment at our center. As such, the severity of corneal thinning or perforation at the time of initial presentation clearly is unlikely to be the result of excessive steroid use. With regard to a standardized treatment approach or criteria for treatment, in view of the significant range of disease severity of corneal involvement, a standardized approach toward frequency of steroids would not be realistic, but we would like to bring the author's attention to the general overview and principles of therapy, as laid out in our “Methods” section. We respectfully defend the use of the adjective severity in the title of our article, simply because our clinical data revealed that corneal involvement was disproportionately more severe in our series of Asian patients as compared with other published studies, and this was extensively addressed in our “Discussion” section. Because corneal involvement may be more immediately sight-threatening than lid involvement, we also believed it appropriate to grade overall disease primarily on the more sight-threatening corneal changes. Because our data also revealed http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Ophthalmology Elsevier
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