Contact Lens-induced Superior Limbic Keratoconjunctivitis

BY ROBERT CAMPBELL, M.D. & PATRICK CAROLINE, C.O.T., F.A.A.O.
FEB. 1996

Contact lens-induced superior limbic keratoconjunctivitis (CL-SLK) is a rather obscure condition with a multifactorial etiology.

Historically, there has been a strong correlation between CL-SLK and the use of solutions that contain thimerosal. This case illustrates our first experience with CL-SLK in a patient who was using a non-thimerosal one-step care system.

PATIENT HISTORY & SYMPTOMATOLOGY

Our patient is a 26-year-old female with a seven-year history of soft contact lens wear. For the past two years she has been wearing daily wear, mid-water, planned frequent replacement (PFR) lenses with routine one month lens replacement. Her lenses are -2.75 sphere OU from which she achieves a stable visual acuity of 20/20 OU. She disinfects her lenses nightly with a one-step care regimen and uses an enzyme cleaner weekly.

The patient recently reported symptoms of bilateral lens awareness with mild photophobia OU. Slit lamp examination revealed:

• Localized hyperemia of the superior bulbar conjunctiva.
• Superior corneal and limbal epithelial irregularity with punctate staining.
• Mild papillary hypertrophy of the superior tarsal conjunctiva.

We diagnosed bilateral contact lens-induced SLK.

FIG. 1: LOCALIZED SUPERIOR BULBAR INJECTION.	FIG. 2: MILD PANNUS FORMATION WITH IRREGULARITY OF THE CORNEA AND CONJUNCTIVAL EPITHELIUM.
FIG. 3: LIMBAL FLUORESCEIN STAINING.

ALLERGY ALERT

The superior limbal area of the eye is very responsive to toxic and allergic stimuli from components in contact lens solutions. There is a massive lymph network in this area and the presence of Trantas dots or tiny limbal follicles should alert you to an allergic reaction.

In CL-SLK, the superior bulbar limbal blood vessels dilate and may release infiltrates. On specular reflection, the perilimbal area may also appear irregular and bumpy with frank epithelial staining. The superior third of the cornea may be edematous with frank superior neovascularization.

We advised our patient to switch to a preservative-free hydrogen peroxide lens care system and preservative-free ocular lubricants. We prescribed fresh PFR contact lenses that were identical to the previous lenses. The condition completely resolved over the next three weeks.

With the advent of new technologies, old complications rarely disappear, they simply appear less frequently. Modern lens care systems have made CL-SLK almost -- but not quite -- a complication of the past. CLS

Dr. Campbell is medical director of the Park Nicollet Contact Lens Clinic & Research Center, Minnetonka, Minn. Patrick Caroline is director of contact lens research at Oregon Health Sciences University, Portland, Ore.