Eyelids & the Anterior Segment:
                  Case twenty three

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This 45 year-old man complained of bilateral ocular irritation which failed to respond to topical antibiotics prescribed by his family doctor.

a. What is the diagnosis?

Superior limbic keratoconjunctivitis (SLK).

The pictures show bilateral upper bulbar conjunctiva hyperaemia. SLK is an uncommon inflammatory disease of the ocular surface which typically affects the middle-aged adults (commoner in females than males). The other signs seen in this condition include: superior corneal micropannus, superior palpebral papillae and filamentary keratitis.

b. How would you treat this condition?

In mild condition, only artificial tear and ointment are needed. In severe cases, the following options may be used:

• application of dilute silver nitrate to the superior bulbar and tarsal conjunctiva
• mechanical scrapping
• thermal cautery to the superior bulbar conjunctiva
• bandage contact lens
• resection or recession of the superior bulbar conjunctiva

c. What other condition(s) may this patient suffers from?

It is estimated that 50% of patients have abnormal thyroid function such as hyperthyroidism. Thyroid function test is recommended in these patients.