Superior limbic keratoconjunctivitis (SLK) is a chronic recurrent inflammatory disease of eye, mainly affecting the cornea and the conjunctiva. Although the exact etiology of this condition is not known, it has been associated with many other conditions such as hypothyroidism, Graves disease, rheumatoid arthritis, keratoconjunctivitis, etc. Frederick Theodore in 1963 was the first person to describe SLK in many patients suffering from inflammation of conjunctiva and cornea without obvious indication of infective pathology.
The symptoms of superior limbic keratoconjunctivitis include sensation of foreign body in eye, burning, excessive tearing, red eye, photophobia etc.However, the visual acuity remains unharmed. The chronic course of superior limbic keratoconjunctivitis may have frequent exacerbations and remissions before it resolves spontaneously. Prognosis of SLK is good after proper treatment.
Causes Of Superior Limbic Keratoconjunctivitis
The exact etiopathogenesis of superior limbic keratoconjunctivitis is not known. It is believed to develop with spontaneity or due to anatomical changes caused by thyroid disease. Continuous mechanical irritation caused by pressure of the upper eyelid on the eye globe or increased motility of the bulbar part of conjunctiva may cause SLK.
Besides thyroid dysfunction, mechanical irritation and injury can be due to infection, injury from surgical procedure, ageing process etc can result in superior limbic keratoconjunctivitis.Some people have proposed autoimmune theory as it is associated with thyroid disease, rheumatoid arthritis and Sogjren’s disease.
Superior limbic keratoconjunctivitis can occur in anyone though it is more prevalent in females and middle aged individuals. Associated risk factors include:
- Thyroid disease such as hypothyroidism and hyperthyroidism.
- Graves’ disease.
- Scar formation on conjunctiva or cornea.
- Conditions that causes reduction in secretion of tears from the eyes. Often rheumatoid arthritis, constant working on computer, etc can cause dryness in eyes.
- Closure of eye for long time can deprive oxygen to the eye.
- Certain eye surgeries that can cause change in the conjunctiva lining.
Symptoms Of Superior Limbic Keratoconjunctivitis
Superior limbic keratoconjunctivitis usually occurs in both the eyes. Common symptoms and signs of this condition are as follows:
- Dryness in eye.
- Itching and burning sensation in eyes.
- Pain in eyes.
- Redness and inflammation of the upper eyelid.
- Gritty sensation as if sensation of sand in the eye.
- Watering from eyes.
- Sensitivity to light.
- Frequent remission and recurrence of the symptoms. These symptoms may last for many years before they abruptly stop.
Treatment For Superior Limbic Keratoconjunctivitis
Superior limbic keratoconjunctivitis is a chronic recurrent condition. There are many treatment modalities that can be used, but there is no specific treatment that can cure. It only helps to alleviate the symptoms.
Following mode of treatment can be used:
- Application of hot fomentation to alleviate itching and irritation in the eye.
- Lubricating eye drops if the eyes are dry.
- Utilization of topical steroid eye drops.
- Special contact lens with large diameter.
- Thermocautery and surgical resection of conjunctiva.
- Treatment of underlying condition such as hypothyroidism, rheumatoid arthritis etc.
- Avoid use of contact lens that are meant for refractory error. Instead patient must wear eye glasses.