Abstract
Purpose :
Superior limbic keratoconjunctivitis (SLK) is a condition which involves a characteristic pattern of inflammation and hyperemia of the superior bulbar conjunctiva. Etiology, and therefore optimal treatment approach, is presently unknown. The purpose of this study was to quantitatively characterize ocular surface and tear properties in SLK, as well as to investigate for associations with systemic inflammatory conditions.
Methods :
A retrospective study of patients diagnosed with SLK under the care of SJ. Patient demographics, symptom grading, physical examination findings, and test results were recorded. Statistical analysis included ANOVA, chi-squared test, or student t-test, as appropriate.
Results :
A total of 18 patients (36 eyes) with SLK were studied. Mean age was 46.1 +/- 10.9 years (range 19 to 75). A majority of patients were female (87.2%). At their initial visit, a majority (58.8%) of patients had severe symptoms (OSDI>33), with a high incidence of light sensitivity (77.8%). Blepharospasm was prevalent (22.2%) and high blink rates were observed (mean 23.0 +/- 2.9 blinks/minute). However, most patients had normal or mildly abnormal Meibomian glands (75.0%, Meibos Scale 0 or 1), and relatively few patients demonstrated substantial tear production deficiency (21.9%, Schirmer I test <5 mm) or decreased tear breakup time (10.0%, <5 seconds). 76.0% of patients had normal tear osmolarity (<300 mOsm/L) but MMP-9 was positive in 83.3%. Systemic autoimmunity testing was performed in eleven patients, and was positive for at least one serum biomarker in two of those tested. Three of the patients demonstrated abnormal thyroid function testing. Along with lubrication, treatment typically included topical steroids, contact lens, autologous serum tears (AST), or some combination thereof. Patients demonstrated a clinically meaningful improvement of 1.5 +/- 0.6 points in symptom intensity over the follow-up time period.
Conclusions :
SLK is associated with inflammatory changes despite relatively normal tear production and quality that may be due to the presence of underlying autoimmune etiology. Patients may present with symptom/sign disconnect. Treatment with AST produced significant symptomatic improvement.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.