Superior Limbic Keratoconjunctivitis Workup

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

Approach Considerations

Superior limbic keratoconjunctivitis (SLK) has been associated with thyroid dysfunction, therefore, investigations into thyroid function, including thyroid-stimulating hormone (TSH), free thyroxine (T4), thyroid-stimulating immunoglobulin, or TSH–binding inhibitory immunoglobulin, may be appropriate. An endocrinologist consultation should be obtained to aid in this workup.

To evaluate for and/or rule out dry eye syndrome, which is often present with superior limbic keratoconjunctivitis (SLK), the Schirmer test, measurement of tear lake, and tear breakup time are used to evaluate for.

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Histologic Findings

Surgical specimens taken from patients with superior limbic keratoconjunctivitis (SLK) who had not received treatment with silver nitrate demonstrate abnormal limbic epithelium with keratinized epithelial cells with dyskeratosis and acanthosis and balloon degeneration of some nuclei. The intracellular accumulation of glycogen in the epithelial cells of tissue sections of the bulbar conjunctiva has been documented. The conjunctival stroma demonstrates edema without significant inflammatory cellular infiltrate. In specimens obtained after silver nitrate treatment, significant numbers of inflammatory cells, including plasma cells, neutrophils, and lymphocytes, also are found in the epithelium and stroma.

Immunohistochemical pathologic examination of the abnormal conjunctiva in superior limbic keratoconjunctivitis demonstrates a lack of the typical mosaic pattern of the epithelium in the resulting keratinized cells before the patient undergoes treatment and upregulation of transforming growth factor-beta 2 and tenascin.[9] In separate studies, increased expression of proliferating cell nuclear antigens and altered expression of cytokines,[10] as well as the presence of involucrin,[11] was shown. More recently, heightened levels of matrix metalloproteinases 1 and 3 have been detected in specimens with the clinical manifestations of SLK.[12]

In vivo laser scanning confocal microscopy has been used to aid in the diagnosis and grading of severity of the unique manifestations of SLK.[13]

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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, 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.

References

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