Superior limbic keratoconjunctivitis
Superior limbic keratoconjunctivitis | |
---|---|
![]() | |
SLK develops due to repeated corneal microtrauma of the cornea and limbus | |
Specialty | Ophthalmology |
Symptoms | Eye redness, burning sensation, tearing |
Duration | Chronic |
Risk factors | 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.[citation needed]
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.[5]
Diagnosis
![]() | This section is empty. You can help by adding to it. (June 2022) |
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.[7]
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.[3] Rarely, it may occur as a consequence of upper eyelid blepharoplasty surgery.[15]
References
- ^ Matsuo, H. (July 1970). "[Superior limbic keratoconjunctivitis (Theodore's syndrome)]". Ganka. Ophthalmology. 12 (7): 612. ISSN 0016-4488. PMID 5466382.
- ^ "Superior limbic keratoconjunctivitis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2017-09-30.
- ^ a b "Superior Limbic Keratoconjunctivitis - EyeWiki". eyewiki.aao.org. Retrieved 2021-07-03.
- ^ Theodore, F. H. (January 1963). "Superior limbic keratoconjunctivitis". Eye, Ear, Nose & Throat Monthly. 42: 25–28. ISSN 0014-5491. PMID 13980870.
- ^ a b "Superior Limbic Keratoconjunctivitis (SLK): Background, Etiology and Pathophysiology, Pathophysiology". 2021-06-17.
{{cite journal}}
: Cite journal requires|journal=
(help) - ^ Cher, Ivan (2000). "Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis". Clinical & Experimental Ophthalmology. 28 (3): 181–184. doi:10.1046/j.1442-9071.2000.00284.x. ISSN 1442-9071. PMID 10981793. S2CID 23900077.
- ^ a b Yokoi, Norihiko; Komuro, Aoi; Maruyama, Kunio; Tsuzuki, Masakatsu; Miyajima, Seiya; Kinoshita, Shigeru (2003-03-01). "New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis". American Journal of Ophthalmology. 135 (3): 303–308. doi:10.1016/S0002-9394(02)01975-X. ISSN 0002-9394. PMID 12614746.
- ^ Perry, Henry D.; Doshi-Carnevale, Sima; Donnenfeld, Eric D.; Kornstein, Howard S. (2003-08-01). "Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis". Ophthalmology. 110 (8): 1578–1581. doi:10.1016/S0161-6420(03)00538-4. ISSN 0161-6420. PMID 12917176.
- ^ 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. 105 (5): 523–527. doi:10.1016/0002-9394(88)90245-0. ISSN 0002-9394. PMID 3285694.
- ^ Goto, Eiki; Shimmura, Shigeto; Shimazaki, Jun; Tsubota, Kazuo (November 2001). "Treatment of Superior Limbic Keratoconjunctivitis by Application of Autologous Serum". Cornea. 20 (8): 807–810. doi:10.1097/00003226-200111000-00006. ISSN 0277-3740. PMID 11685056. S2CID 22666102.
- ^ 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. 26 (4): 423–426. doi:10.1097/ICO.0b013e318030d230. ISSN 0277-3740. PMID 17457190. S2CID 43314789.
- ^ Udell, Ira J.; Kenyon, Kenneth R.; Sawa, Mitsuru; Dohlman, Claes H. (1986-02-01). "Treatment of Superior Limbic Keratoconjunctivitis by Thermocauterization of the Superior Bulbar Conjunctiva". Ophthalmology. 93 (2): 162–166. doi:10.1016/S0161-6420(86)33766-7. ISSN 0161-6420. PMID 3951822.
- ^ Passons, Gary A.; Wood, Thomas O. (1984-08-01). "Conjunctival Resection for Superior Limbic Keratoconjunctivitis". Ophthalmology. 91 (8): 966–968. doi:10.1016/S0161-6420(84)34207-5. ISSN 0161-6420. PMID 6493706.
- ^ Nelson, J. D. (March 1989). "Superior limbic keratoconjunctivitis (SLK)". Eye. 3 (2): 180–189. doi:10.1038/eye.1989.26. ISSN 1476-5454. PMID 2695351.
- ^ 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. doi:10.1097/ICO.0b013e3180303b02. ISSN 0277-3740. PMID 17457203. S2CID 38690433.
External links