Superior Limbic Keratoconjunctivitis Treatment & Management

  • Author: James H Oakman Jr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 26, 2011
 

Approach Considerations

Superior limbic keratoconjunctivitis (SLK) is managed by various treatment options, none of which has been completely effective. Therapeutic approaches have been aimed primarily toward speeding the patient's recovery and providing symptomatic relief.

See the following for more information:

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Pharmacologic Treatment

Pressure patching, placement of a bandage contact lens (primarily or as an adjunct), silver nitrate solution application, mast cell stabilizers,[14, 15] vitamin A preparations,[16] cyclosporine A,[6] autologous serum–derived drops,[17] and botulinum injection to the overlying muscle of Riolan[18] have been used with moderate success for managing superior limbic keratoconjunctivitis (SLK). Because these approaches usually offer only temporary mitigation of symptoms, more definitive treatments (eg, surgical resection of the bulbar conjunctiva) are often required.

It is important to keep in mind that inappropriate use of silver nitrate sticks—which should never be used in the eyes, as opposed to preparations of topical silver nitrate solution—results in a severe caustic injury to the affected part of the eye where applied.

Supratarsal triamcinolone injection has had reported success in mitigating signs and symptoms and may be helpful as an adjunctive therapy.[19]

A 10-day course of lodoxamide, 4 times per day, has been shown in a series of 3 patients to mitigate the symptoms of SLK. Again, this is not considered definitive treatment by most.

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Cryotherapy

Liquid nitrogen cryotherapy as a single application or repeated for recalcitrant SLK appears to be a safe and effective therapy using a double freeze-thaw technique with the patient under topical anesthesia.[16]

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Surgical Resection

When noninvasive or less invasive treatment modalities fail in the treatment of superior limbic keratoconjunctivitis (SLK), surgical intervention is an alternative.[20]

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,[21] and keratinized epithelium is replaced by normal ingrowth.[22, 14] Thermocautery accomplishes 2 of these treatment objectives.[15] Autologous serum application has been shown to be beneficial as an alternative therapy in a small case series.[23] Adjunctive superior lacrimal punctal occlusion,[24] bandage contact lens application,[25, 26] and amniotic membrane grafting[27] have been advocated but are not widely used.

Surgical resection of the conjunctiva has the usual complication profile of any surgical procedure, and special care should be taken to avoid involvement of the superior rectus muscle in the dissection.

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Patient Education and Follow-up

Discussing the disease process with patients is important, because it will improve compliance with treatment modalities. This discussion will help to allay their fear of the unknown and will also help them to cope with the often prolonged symptoms of this entity.

Patients should receive follow-up care for recurrences of symptoms after treatment of superior limbic keratoconjunctivitis (SLK), and they require careful examinations for the development of thyroid ophthalmopathy.

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Proceed to Medication
 
 
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, Association of American Physicians and Surgeons, Georgia Medical Society, Georgia Society of General Surgeons, and Georgia Society of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director 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; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

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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