Superior Limbic Keratoconjunctivitis

Clinical Features

Symptoms: foreign body sensation, burning and photophobia.
Signs:
- Fine papillary hypertrophy on the superior tarsal conjunctiva
- Intense hyperemia of the superior bulbar conjunctiva with engorgement of the vertical blood vessels
- Keratinization or thickening of the superior limbal conjunctiva, which can be demonstrated with rose bengal staining
- Punctate epithelial erosions on the upper third of cornea and occasionally coneal filaments.
There is an increased incidence in patient with thyroid associated ophthalmopathy.
Etiology is unclear, however alteration of tear film production, defective blinking due to lid retraction and excessive pressure on the superior limbus from the retracted lid may all lead to the changing of normal lid-globe mechanical interaction.
Differential diagnosis includes idiopathic SLK of Theodore (an uncommon, chronic, bilateral, inflammatory disorder which typically affects middle-aged women) and contact lens-related SLK secondary to improper lens fit or hypersensitivity to preservatives in lens care solution such as thimerosal.

Medical treatment includes topical lubrication and/or topical steroids.
In contact lens-related SLK, discontinuing contact lens wear for a period of time will improve the condition, while bandage soft contact lenses are beneficial for idiopathic SLK of Theodore.
Remission usually occurs when the proptosis resolves, however it may recur over a course of several years.
If medical treatment fails management options include cauterization of superior bulbar conjunctiva or conjunctival resection