Superior limbic keratoconjunctivitis explained

Superior limbic keratoconjunctivitis
Field:ophthalmology
Symptoms:Eye redness, burning sensation, tearing
Duration:Chronic
Risks:Corneal microtrauma, hyperthyroidism, hyperparathyroidism
Treatment:Topical corticosteroids, artificial tears, surgery
Prognosis:Exacerbations decrease with age

Superior limbic keratoconjunctivitis (SLK, Théodore's syndrome[1] ) is a disease of the eye[2] characterized by episodes of recurrent inflammation of the superior cornea and limbus, as well as of the superior tarsal and bulbar conjunctiva.[3] It was first described by F. H. Théodore in 1963.[4]

Symptoms and signs

Patients present with red eye, burning, tearing, foreign body sensation and mild photophobia.[5] Upon examination, the conjunctiva appears inflamed and thickened, especially at the limbus.

Pathophysiology

The development and pathophysiology of SLK is not well understood, but appears to involve microtrauma of keratoconjunctival surfaces.[6] This mechanical hypothesis is supported by the increased lid apposition of exophthalmic thyroid patients, who are known to have an increased incidence of superior limbic keratoconjunctivitis.

Treatment

First-line treatments include topical corticosteroids and artificial tears.[7] For non-responsive cases, potential treatments include topical ciclosporin A,[8] vitamin A,[9] autologous serum[10] and injections of triamcinolone.[11] Surgical treatment options include thermocauterization of the bulbar conjunctiva[12] and conjunctival resection,[13] typically under rose bengal (RB) staining to visualize affected areas.

Epidemiology

Superior limbic keratoconjunctivitis tends to occur more often with dry eye syndrome (keratoconjunctivitis sicca), hyperthyroidism and hyperparathyroidism.[14] It is also a rare complication associated with rheumatoid arthritis. Rarely, it may occur as a consequence of upper eyelid blepharoplasty surgery.[15]

Notes and References

  1. Matsuo. H.. July 1970. [Superior limbic keratoconjunctivitis (Theodore's syndrome)]]. Ganka. Ophthalmology. 12. 7. 612. 0016-4488. 5466382.
  2. Web site: Superior limbic keratoconjunctivitis Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. rarediseases.info.nih.gov. en. 2017-09-30.
  3. Web site: Superior Limbic Keratoconjunctivitis - EyeWiki. 2021-07-03. eyewiki.aao.org. en.
  4. Theodore. F. H.. January 1963. Superior limbic keratoconjunctivitis. Eye, Ear, Nose & Throat Monthly. 42. 25–28. 0014-5491. 13980870.
  5. 2021-06-17. Superior Limbic Keratoconjunctivitis (SLK): Background, Etiology and Pathophysiology, Pathophysiology.
  6. Cher. Ivan. 2000. Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis. Clinical & Experimental Ophthalmology. en. 28. 3. 181–184. 10.1046/j.1442-9071.2000.00284.x. 10981793. 23900077. 1442-9071.
  7. 2003-03-01. New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis. American Journal of Ophthalmology. en. 135. 3. 303–308. 10.1016/S0002-9394(02)01975-X. 0002-9394. Yokoi. Norihiko. Komuro. Aoi. Maruyama. Kunio. Tsuzuki. Masakatsu. Miyajima. Seiya. Kinoshita. Shigeru. 12614746.
  8. 2003-08-01. Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis. Ophthalmology. en. 110. 8. 1578–1581. 10.1016/S0161-6420(03)00538-4. 0161-6420. Perry. Henry D.. Doshi-Carnevale. Sima. Donnenfeld. Eric D.. Kornstein. Howard S.. 12917176.
  9. Ohashi. Yuichi. Watanabe. Hitoshi. Kinoshita. Shigeru. Hosotani. Hisashi. Umemoto. Masayo. Manabe. Reizo. 1988-05-01. Vitamin A Eyedrops for Superior Limbic Keratoconjunctivitis. American Journal of Ophthalmology. English. 105. 5. 523–527. 10.1016/0002-9394(88)90245-0. 0002-9394. 3285694.
  10. Goto. Eiki. Shimmura. Shigeto. Shimazaki. Jun. Tsubota. Kazuo. November 2001. Treatment of Superior Limbic Keratoconjunctivitis by Application of Autologous Serum. Cornea. en-US. 20. 8. 807–810. 10.1097/00003226-200111000-00006. 11685056. 22666102. 0277-3740.
  11. Shen. Ying-Cheng. Wang. Chun-Yuan. Tsai. Hin-Yeung. Lee. Yi-Fen. May 2007. Supratarsal Triamcinolone Injection in the Treatment of Superior Limbic Keratoconjunctivitis. Cornea. en-US. 26. 4. 423–426. 10.1097/ICO.0b013e318030d230. 17457190. 43314789. 0277-3740.
  12. 1986-02-01. Treatment of Superior Limbic Keratoconjunctivitis by Thermocauterization of the Superior Bulbar Conjunctiva. Ophthalmology. en. 93. 2. 162–166. 10.1016/S0161-6420(86)33766-7. 0161-6420. Udell. Ira J.. Kenyon. Kenneth R.. Sawa. Mitsuru. Dohlman. Claes H.. 3951822.
  13. 1984-08-01. Conjunctival Resection for Superior Limbic Keratoconjunctivitis. Ophthalmology. en. 91. 8. 966–968. 10.1016/S0161-6420(84)34207-5. 0161-6420. Passons. Gary A.. Wood. Thomas O.. 6493706.
  14. Nelson. J. D.. March 1989. Superior limbic keratoconjunctivitis (SLK). Eye. en. 3. 2. 180–189. 10.1038/eye.1989.26. 2695351. 1476-5454. free.
  15. Sheu. Mike C.. Schoenfield. Lynn. Jeng. Bennie H.. May 2007. Development of superior limbic keratoconjunctivitis after upper eyelid blepharoplasty surgery: support for the mechanical theory of its pathogenesis. Cornea. 26. 4. 490–492. 10.1097/ICO.0b013e3180303b02. 0277-3740. 17457203. 38690433.

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