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
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