Cosmetic scleral shells provide a superior alternative to enucleation or evisceration in the setting of phthisis bulbi. However, corneal irritation often minimizes the wearing time of a scleral shell. This study aimed to evaluate the clinical effectiveness of a total conjunctival flap covering in the management of mild phthisis bulbi with a sensitive cornea. The surgical technique involved a total conjunctival flap covering combined with superficial lamellar keratectomy to allow the fitting of a cosmetic scleral shell over a sensitive cornea. The records of patients with mild phthisis bulbi who underwent this technique from September 2003 through July 2011 were reviewed. Postoperative and long-term complications were noted. Outcome measures included cosmetic appearance, complications, and patient satisfaction. A total of 58 patients (58 eyes) were identified. The mean age at surgery was 28.5 years (range = 2-65 years) and the mean follow-up period (follow-up rate = 66 %) was 42.6 months (range = 6-98 months). Postoperative complications like epithelial inclusion cyst (one eye), intolerance of scleral shell wear (2 eyes), and deterioration of phthisis bulbi (3 eyes) were observed during the follow-up interval. Surgical success was achieved in 52 subjects (90 %) with the desired prosthetic appearance and motility and no further intervention was required. The total conjunctival flap is an easy and effective globe-conserving alternative to enucleation or evisceration in the cosmetic rehabilitation of patients with mild phthisis bulbi. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <ExternalRef> <RefSource>www.springer.com/00266</RefSource> <RefTarget Address="http://www.springer.com/00266" TargetType="URL"/> </ExternalRef>.