SUPERIOR LIMBIC KERATOCONJUNCTIVITIS

Superior limbic keratoconjunctivitis of Theodore is the name given to inflammation of superior limbic, bulbar and tarsal conjunctiva associated with
punctate keratitis of the superior part of
cornea.

Etiology
Exact etiology is not known. It occurs with greater frequency in patients with hyperthyroidism and is more common in females.

Clinical features
Clinical course. It has a chronic course with remissions and exacerbations.
Symptoms include :
Bilateral ocular irritation.
Mild photophobia, and redness in superior bulbar conjunctiva.

Signs (Fig. 1) include
Congestion of superior limbic, bulbar and tarsal conjunctiva.
Punctate keratitis which stains with fluorescein and rose bengal stain is seen in superior part of cornea.
Corneal filaments are also frequently seen in the involved area.

Fig. 1. Superior limbic keratoconjunctivitis : A,
diagramatic depiction; B, clinical photograph.

Treatment
1. Topical artificial tears.
2. Low doses of topical corticosteroids may reduce the symptoms temporarily.
3. Faint diathermy of superior bulbar conjunctiva in a checker board pattern gives acceptable results.
4. Recession or resection of a 3-4 mm wide perilimbal strip of conjunctiva from the superior limbus (from 10.30 to 1.30 O'clock position) may be helpful if other measures fail.
5. Therapeutic soft contact lenses for a longer period may be helpful in healing the keratitis.

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