- Clinical features:
- Symptoms: foreign body sensation, burning and photophobia.
- Signs:
- Fine papillary hypertrophy on the superior tarsal conjunctiva
- Intense hyperemia of the superior bulbar conjunctiva with
engorgement of the vertical blood vessels
- Keratinization or thickening of the superior limbal conjunctiva,
which can be demonstrated with rose bengal staining
- Punctate epithelial erosions on the upper third of cornea
and occasionally coneal filaments.
- There is an increased incidence in patient with thyroid associated
ophthalmopathy.
- Etiology is unclear, however alteration of tear film production,
defective blinking due to lid retraction and excessive pressure
on the superior limbus from the retracted lid may all lead to
the changing of normal lid-globe mechanical interaction.
- Differential diagnosis includes idiopathic SLK of Theodore (an
uncommon, chronic, bilateral, inflammatory disorder which typically
affects middle-aged women) and contact lens-related SLK secondary
to improper lens fit or hypersensitivity to preservatives in lens
care solution such as thimerosal.
- Management:
- Medical treatment includes topical lubrication and/or topical
steroids.
- In contact lens-related SLK, discontinuing contact lens wear
for a period of time will improve the condition, while bandage soft
contact lenses are beneficial for idiopathic SLK of Theodore.
- Remission usually occurs when the proptosis resolves, however
it may recur over a course of several years.
- If medical treatment fails management options include cauterization
of superior bulbar conjunctiva or conjunctival resection.
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