Unusual appearance of condensed chromatin in conjunctival cells in superior limbic keratoconjunctivitis

Superior limbic keratoconjunctivitis: Update on pathophysiology and management

Superior limbic keratoconjunctivitis (SLK) is an under-recognized condition characterized by a final common pathologic presentation of superior conjunctival and limbal inflammation and staining. Existing literature attributes both microtrauma and local inflammation, frequently in the setting of tear film insufficiency, as the underlying mechanisms that lead to a self-perpetuating pathologic process dependent in on inflammatory cells and signaling. Effective treatments act by targeting inflammation and by mitigating mechanical stressors. This critical review discusses the latest in our understanding of the pathophysiology of SLK and how it guides our treatment strategies.

Superior limbic keratoconjunctivitis: a comprehensive review

Superior limbic keratoconjunctivitis (SLK) is characterized by chronic inflammation of the superior limbus and superior bulbar and tarsal conjunctivae. Patients also often have fine punctate staining of the limbus and adjacent area, superior limbic proliferation seen as thickening of the limbal epithelium and surrounding conjunctiva, and occasionally filaments at the superior limbus and upper cornea. SLK frequently presents with ocular irritation, foreign body sensation, and photophobia. SLK can be associated with other ocular and non-ocular conditions, such as thyroid disease. Although the pathogenesis of SLK is still unknown, it is thought to be related to mechanical injury, tear film instability, or an autoimmune/inflammatory etiology. Many patients with SLK can be asymptomatic or have symptoms that resolve or remit spontaneously. For symptomatic SLK, patients are managed medically with treatments such as lubricants, topical anti-inflammatory or immunomodulatory medications, punctal occlusion, and bandage contact lenses. Patients with symptoms refractory to medical management may need surgical interventions. We detail the current literature on the epidemiology, clinical manifestations, associated conditions, histopathology, pathogenesis, and treatment of SLK.

Klassifikation der Erkrankungen der Augenoberfl�che

The ocular surface consists of the lid margin, conjunctiva and cornea which together with the tear system represent a functional entity. The diagnosis of ocular surface disease can be very difficult due to the similarity of various disease entities. The classification should be made on the pathological and pathophysiological characteristics of ocular surface disease. The first part of the classification comprises diseases of the lid margin, the tear system as well as diseases of the conjunctiva. Both the clinical presentation as well as the underlying pathophysiological and pathological characteristics of the most important ocular surface diseases are reviewed.

Blink-related microtrauma: when the ocular surface harms itself

Superior limbic keratoconjunctivitis results mechanically from blinking under prolonged unphysiological conditions. The pathogenic process is known as blink-related microtrauma. This review aimed to explore the validity of a general theory that besides superior limbic keratoconjunctivitis, there may be other diseases of the ocular surface arising from mechanical microtrauma. A review of relevant clinical and microscopic lesions in a range of ocular surface disorders with possible mechanical aetiology was conducted. New terms were selected to facilitate understanding of such new aetiology. Besides superior limbic keratoconjunctivitis, other ocular surface disorders regarded as primarily derived from blink microtrauma are: other filamentary keratitides; blepharospasm and severe ptosis; canthal/palpebral froth; affections from disordered eyelid lining; and contact lens related damage. A group of secondarily microtraumatic disorders was identified, including the example of microtrauma impacting upon interpalpebral bulbar prominences. Superior limbic keratoconjunctivitis is the archetype of diseases affecting a unique combination; namely, the ocular surface conjoined with its lacrimal fluid. It is only one among many diseases actively generated within the confines of 'a self-harming surface'.

Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis

Origins of superior limbic keratoconjunctivitis (SLK) are not well understood. Prompted by suggestions that pressure and friction may contribute to SLK, this paper, using evidence from the literature and from personal Kodachrome records, aims to assess, and if appropriate, enhance this understanding. The survey disclosed evidence confirming mechanical aetiology. Support is presented for the notion that SLK arises from soft tissue microtrauma: (i) between tarsal and bulbar surfaces; and (ii) between conjunctival stroma and sclera. In each pair the two apposed tissues are in repetitive motion relative to each other. It is concluded that SLK arises because nonstandard combinations of multiple predisposing and/or trigger factors exceed the physiological tolerance of mechanical stresses upon the ocular surface and tissues. Through their effects on particular tissues, eight separate stressing forces were perceived. The many contributing factors in four categories are integrated into a new aetiologic concept.

Superior limbic keratoconjunctivitis (SLK)

Superior limbic keratoconjunctivitis (SLK) is a disease characterised by inflammation of the upper palpebral and superior bulbar conjunctiva, keratinisation of the superior limbus and corneal and conjunctival filaments. It may be associated with other diseases such as keratoconjunctivitis sicca, hyperthyroidism and hyperparathyroidism. Although its exact aetiology is unknown, a mechanical hypothesis seems most attractive. Treatment is aimed at altering the abnormal mechanical interaction of the upper lid and superior corneal limbus.