Superior limbic keratoconjunctivitis (SLK, Théodore's syndrome) is a disease of the eye characterized by episodes of recurrent

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

of the superior

cornea The cornea is the transparency (optics), transparent front part of the eyeball which covers the Iris (anatomy), iris, pupil, and Anterior chamber of eyeball, anterior chamber. Along with the anterior chamber and Lens (anatomy), lens, the cornea ...

and

limbus Limbus (Lat. "edge, boundary") may refer to: * Corneal limbus, the border of the cornea and the sclera (the white of the eye) * Limbus of fossa ovalis, in the heart * Limbus 3 and Limbus 4, two line-ups of a German avant-garde musical group * ...

, as well as of the superior tarsal and bulbar

conjunctiva In the anatomy of the eye, the conjunctiva (: conjunctivae) is a thin mucous membrane that lines the inside of the eyelids and covers the sclera (the white of the eye). It is composed of non-keratinized, stratified squamous epithelium with gobl ...

. It was first described by F. H. Théodore in 1963.

Symptoms and signs

Patients present with red eye, burning, tearing, foreign body sensation and mild

photophobia Photophobia is a medical symptom of abnormal intolerance to visual perception of light. As a medical symptom, photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence o ...

. 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. 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.

Diagnosis

Treatment

First-line treatments include topical

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s and

artificial tears Artificial tears are lubricating eye drops used to relieve dryness and irritation of the ocular surface. Dry eye syndrome ( keratoconjunctivitis sicca) is a common ocular surface disorder and is characterized by disruption of the tear film and ...

. For non-responsive cases, potential treatments include topical ciclosporin A,

vitamin A Vitamin A is a fat-soluble vitamin that is an essential nutrient. The term "vitamin A" encompasses a group of chemically related organic compounds that includes retinol, retinyl esters, and several provitamin (precursor) carotenoids, most not ...

, autologous serum and injections of

triamcinolone Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and chronic obstructive pulmonary disease (COPD). It can be taken in variou ...

. Surgical treatment options include thermocauterization of the bulbar conjunctiva and conjunctival resection, 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 Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...

and

hyperparathyroidism Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels in the blood. This occurs from a disorder either within the parathyroid glands ( primary hyperparathyroidism) or as response to external stimuli ( secondary hyperparathyroi ...

. It is also a rare complication associated with rheumatoid arthritis. Rarely, it may occur as a consequence of upper eyelid

blepharoplasty Blepharoplasty (Greek: ''blepharon'', "eyelid" + ''plassein'' "to form") is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With ...

surgery.

References

External links

Eye diseases Inflammations Disorders of conjunctiva {{eye-stub