June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Incidence and Predictors of SLK in Thyroid Eye Disease
Author Affiliations & Notes
  • Nabill Munshi
    University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
    Charles Drew University of Medicine and Science, Los Angeles, California, United States
  • Robert Goldberg
    Orbit & Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, California, United States
  • Daniel Rootman
    Orbit & Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, California, United States
    Orbit & Ophthalmic Plastic Surgery, Doheny Eye Institute, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Nabill Munshi None; Robert Goldberg Horizon Pharmaceuticals, Code C (Consultant/Contractor); Daniel Rootman Horizon Pharmaceuticals, Code C (Consultant/Contractor)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4000 – A0342. doi:
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      Nabill Munshi, Robert Goldberg, Daniel Rootman; Incidence and Predictors of SLK in Thyroid Eye Disease. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4000 – A0342.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Thyroid Eye Disease (TED) is an autoimmune disease that affects 20-25% of patients with Grave’s disease. In the course of TED, the eyelids, orbital fat, orbital adnexa, ocular surface and extra ocular muscles have the potential to be affected. TED can be detrimental to patients both physiologically and psychologically, thus severely affecting a patients quality of life. Ocular surface irritation is a common complaint for patients with TED, and it can be multifactorial. One of the lesser studied causes of this discomfort is superior limbic keratoconjunctivitis (SLK). The focus of this study was on understanding SLK incidence in patients diagnosed with TED and what factors may contribute to SLK manifestation.

Methods : Consecutive patients presented to a TED clinic over a 2 year period. A complete thyroid related history and examination was performed following the VISA template. The presence of SLK was determined by the staining of lissamine green of the superior limbus. Other TED markers, such as changes to eyelid position, proptosis and strabismus were recorded. Ocular surface factors were also recorded. All data was extracted and stored in a TED related database. The incidence of SLK was calculated and binary and multivariate statistics were performed to determine potential associated factors.

Results : Sample consisted of 268 patients. The SLK incidence in this cohort was found to be 5%. Bivariate statistical analysis showed no relationship/difference between various demographics, thyroid bloodwork, eyelid position and signs of corneal disease.

Conclusions : Typical demographic, clinical and serum values of TED were not predictive of SLK. A clear relationship between SLK incidence and severity of TED or characteristics of TED was not found. SLK remains an idiosyncratic reaction affecting approximately 5% of patients with TED.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.




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