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The Two Years Old Eye Irritation

Mr. Iyer* a 52-year-old man, came with a complaints of repeated episodes of terrible eye irritation since two years. Mr Iyer who also suffers from hyperthyroidism had previously received steroid eye drops for duration of three months...thrice! Not to mention, Mr Iyer was absolutely exasperated with his eye problems. When his eyes were checked, his visual acuity (or sharpness of vision) was 20/20 (normal) in both eyes.

Dr Vandana Jain examined his eyes to find that the upper part of both his eyes showed redness. Dr Jain found that his conjunctiva (the outermost clear membrane of his eye) showed laxity, more prominent in the upper part. The upper tarsal (part on the inner side of the lids) conjunctiva showed a papillary reaction.

 

                           Redness Of Upper Conjunctiva

 

Testing of his tear secretion revealed 5 mm of wetting after 5 minutes, in both the eyes. (This is done using Basal tear secretion test where a paper strip is placed into the eye for several minutes to measure the amount of moisture. It should normally be more than 15 mm). Tear film break-up time (TBUT) was 7 and 8 seconds respectively in the right and left eye. (In testing for TBUT, a dye is added to the eye and the tear film is observed under the slit lamp until tiny dry spots develop. The longer it takes, the more stable the tear film. A short tear break-up time is a sign of a poor tear film. Generally, >10 seconds is thought to be normal)

The patient was diagnosed with Superior limbic Keratoconjunctivitis (Inflammation of the cornea and conjunctiva) with dry eye. He was started on prednisolone acetate 1% three  times daily in weekly tapering doses, preservative-free artificial tears six times daily and collagen punctal plugs were inserted in both the eyes. 

Mr Iyer came back two weeks later without much reduction of symptoms. He was started on Restasis (eye drops for increasing tear production) two times a day in both eyes. After 12 weeks, his upper lax conjunctiva was removed and amniotic membrane was glued. (Amniotic membrane is obtained from the sac in which a baby develops and is used as a graft). Within a few weeks, Mr Iyer joyfully reported that all his symptoms had vanished. Dr Jain noted that his TBUT had improved to 10 and 11 seconds and the basic tear secretion to 22mm and 17mm respectively in right and left eyes.

 

Take Home Message

Superior Limbic Keratoconjunctivitis (SLK) is an uncommon inflammatory eye surface disorder.  Patient complains of really bad eye irritation and feeling of dryness. When examined, there is redness of the upper part of the conjunctiva, staining, and filaments in the upper part of the cornea (dome shaped transparent structure).

SLK is a disease with many causes. A study has found that mechanical cause with repeated minor injuries caused during blinking is one of the responsible factors. This is evident by and also increased by the lax conjunctiva on the upper part. In such cases localised conjunctival removal with amniotic membrane transplantation is very helpful. 

About Advanced Eye Hospital and Institute:

Advanced Eye Hospital and Institute in Navi Mumbai is one of the best eye hospitals in Mumbai.  Comprehensive eye check-up rooms and the operation theatres are state-of-art and equipped with the best diagnostic and surgery machines. Personalised care, infection free modular operation theatres and beautiful ambience compliment the cutting-edge eye care offered at AEHI. Besides treating patients from Kharghar, Nerul, Vashi and Panvel, patients from all over western India travel to AEHI for world class eye care management.