Superior Limbic Keratoconjunctivitis
This is characterized by inflammation of the superior tarsal and conjunctival layer of bulb and oedema of the corneoscleral limbal conjunctiva; corneal filaments are frequently present.
Fine punctate fluorescein and Rose bengal staining of the superior cornea, limbus and conjunctiva are commonly found. Fine papillae could also be seen on the superior palpebral conjunctiva and a superior corneal pannus may develop.
The condition is typically bilateral, occurs frequently in females and follows a chronic course with remissions and exacerbations. The prognosis is superb as eventual resolution usually occurs.
There is a robust association with thyroid disease.
Hence thyroid function tests and clinical evaluation for thyroid dysfunction should be performed.
Management:
Treatment is symptomatic, with the liberal use of topical ocular lubricants.
Temporary punctal occlusion with collagen punctual plugs, if required.
Any concurrent blepharitis should be treated with antibiotic ointment like erythromycin or chloramphenicol applied fourfold daily for 1 week.
If corneal filaments and mucus strands are present in excessive amounts, then acetylcysteine 10% drops are added three to 5 times each day .
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