Severe ocular surface disease can be the sequela of numerous types of damage and a variety of disorders. Historically, severe ocular surface disease has been a challenge to treat. Only 30 years ago there was a poor prognosis for patients with severe ocular surface disease. With advances in microsurgical techniques, stem cell research and use of amniotic membranes, the current prognosis for patients is much improved. Current work with limbal stem cell cultures offers the potential for even greater successes with decreased harvesting area and less need for immunosuppressive agents. These great advances create optimism that the next 30 years will show continued progress in the treatment and prognosis for patients with severe ocular surface disease.