eMedicine Specialties > Ophthalmology > Cornea

Keratoconjunctivitis, Superior Limbic: Treatment & Medication

Author: James H Oakman Jr, MD, Partner, Southern Eye Center, Augusta, Georgia
Contributor Information and Disclosures

Updated: Nov 6, 2008

Treatment

Medical Care

Several approaches are used by practitioners to speed the recovery of patients toward the resolution of symptoms. Pressure patching, placement of a bandage contact lens (primarily or as an adjunct), silver nitrate solution application, mast cell stabilizers, vitamin A preparations, and cyclosporine A6 have been used with moderate success. Supratarsal triamcinolone injection has had reported success in mitigating signs and symptoms and may be helpful as an adjunctive therapy.7 As these approaches usually offer only temporary mitigation of symptoms, more definitive treatments often are required.

Surgical Care

Surgical resection of the involved conjunctiva as delineated intraoperatively by the use of rose bengal staining removes the affected tissue. Folds of superfluous conjunctiva are eliminated, adhesions with underlying Tenon capsule and episclera develop, which may be augmented by transplantation of cryopreserved amniotic membrane with fibrin glue,8 and keratinized epithelium is replaced by normal ingrowth.9,10 Thermocautery accomplishes 2 of these treatment objectives. Autologous serum application has been shown to be beneficial as an alternative therapy in a small case series.11 Superior lacrimal punctal occlusion and bandage contact lens application have been advocated but are not widely used.

Consultations

Appropriate investigations into thyroid function may involve an endocrinologist consultation.

Medication

Both mast cell stabilizers and vitamin A preparations have been used with moderate success. However, these approaches usually offer only temporary mitigation of symptoms, and more definitive treatments often are required. Preservative-free artificial tears also may be helpful.

Recently, topical cyclosporine A has been shown to provide symptom relief and to improve the signs of SLK; however, maintenance therapy is required for continued benefit.12

Mast cell stabilizers

Long-term inhibition of inflammation. Inhibits type 1 immediate hypersensitivity reaction.


Lodoxamide tromethamine 0.1% (Alomide)

Mast cell stabilizer with reported efficacy in the treatment of SLK.

Adult

1 gtt qid for 10 d to affected eye(s)

Pediatric

<2 years: Not established
>2 years: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Often experience transient burning or stinging from instillation of medication; soft contact lens wearers should refrain from using while under treatment


Cromolyn sodium 4% (Crolom, Intal)

Mast cell stabilizer with reported efficacy in the treatment of SLK.

Adult

1 gtt q3-4h until symptoms improve (approximately 1 mo); then, taper dosage to maintain control of symptoms

Pediatric

<5 years: Not established
>5 years: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Soft contact lens wearers should refrain from using lenses while under this treatment; do not use in severe renal or hepatic impairment; symptoms may reoccur when withdrawing drug

Cauterizing agents

Topical application for treatment of keratinized conjunctiva


Silver nitrate solution

An application to anesthetized conjunctiva usually relieves symptoms of SLK for 4-6 weeks. Then, the treatment can be repeated safely.

Adult

0.5-1% solution: Make fresh each day for use and discard afterwards; apply to anesthetized upper tarsus, which then is allowed to fall back into place over affected palpebral conjunctiva; irrigation with sterile saline after 1 min follows this application

Pediatric

Administer as in adults

Decreases effects of sulfacetamide preparations

Documented hypersensitivity; broken skin or cuts

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use silver nitrate sticks; not for internal use

Immunomodulators

These agents modulate key factors of the immune system.


Cyclosporine A, 0.05% topical (Restasis)

Used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. Thought to act as partial immunomodulator. Exact mechanism of action is not known.

Adult

Instill 1 gtt in each eye q6h

Pediatric

<16 years: Not established
>16 years: Administer as in adults

Documented hypersensitivity; ocular infection

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Herpes keratitis; do not administer while wearing contact lenses; may cause ocular burning, conjunctival hyperemia, ocular discharge, excessive tearing, eye pain, foreign body sensation, pruritus, stinging, or blurred vision

More on Keratoconjunctivitis, Superior Limbic

Overview: Keratoconjunctivitis, Superior Limbic
Differential Diagnoses & Workup: Keratoconjunctivitis, Superior Limbic
Treatment & Medication: Keratoconjunctivitis, Superior Limbic
Follow-up: Keratoconjunctivitis, Superior Limbic
References
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References

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Further Reading

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Keywords

superior limbic keratoconjunctivitis, SLK, superior limbic filamentary keratoconjunctivitis

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Contributor Information and Disclosures

Author

James H Oakman Jr, MD, Partner, Southern Eye Center, Augusta, Georgia
James H Oakman Jr, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Georgia Medical Society, Georgia Society of General Surgeons, and Georgia Society of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Stephen D Plager, MD, FACS, Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital
Stephen D Plager, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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