Superior limbic keratoconjunctivitis is a newly recognized entity of unknown etiology, characterized by diffuse superior palpebral conjunctivitis, localized superior bulbar conjunctivitis, superior limbic changes, punctate staining of the involved superior bulbar conjunctiva with fluorescein and rose bengal, and, in many instances, upper corneal filaments. Cultures are essentially negative. Scrapings of the involved superior bulbar conjunctiva are valuable diagnostically, showing marked keratinization of the epithelial cells and polymorphs; scrapings of the palpebral conjunctiva reveal normal epithelium and a polymorphonuclear exudate. Biopsy specimens of the superior bulbar conjunctiva confirm findings on scrapings, showing prominent keratinization of the epithelium with acanthosis, dyskeratosis, cellular infiltration, and in some areas, balloon degeneration of the nuclei. Biopsy of the palpebral conjunctiva reveals infiltration with polymorphs, lymphocytes and plasma cells, and normal epithelium.
Theodore FH, Ferry AP. Superior Limbic Keratoconjunctivitis: Clinical and Pathological Correlations. Arch Ophthalmol. 1970;84(4):481–484. doi:10.1001/archopht.1970.00990040483016
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