Limbal keratoconjunctivitis above Theodore
Introduction
Introduction to the upper limbal keratoconjunctivitis of Theodore Superimorlimbickeratoconjunctivitis of Theodore (SLK) is a disease characterized by above-mentioned palpebral conjunctiva, superior conjunctiva, superior corneal limbus, and chronic keratoconjunctivitis with recurrent episodes of the cornea. The etiology is unknown. Mostly bilateral onset. One third of the patients were accompanied by upper corneal epithelial filaments. basic knowledge Sickness ratio: 0.5% Susceptible people: no specific population Mode of infection: non-infectious Complications: dry keratoconjunctivitis
Cause
Causes of limbal keratoconjunctivitis above Theodore
(1) Causes of the disease
The cause is unclear. Although bacteria, viruses, fungi, chlamydia infection and immune response have been proposed in the past, there is no evidence to confirm that Eiferman and Wilkins (1979) have performed immunological evaluation of 3 patients undergoing conjunctival resection. No specific immunodeficiency was found. Therefore, it is inferred that this disease has no immunological basis, but this disease has some association with many other diseases. The most common is thyroid disease. Tenzel (1968) first discovered this association and found that Many patients have elevated levels of bound protein iodine in their serum, which was later confirmed by Cher (1969). It is found that SLK patients have thyroitoxicosis, and Theodore (1968) also agrees with Tenzel's research because Many patients have also been found to have evidence of thyroid dysfunction. The association of SLK with thyroid dysfunction, especially hyperthyroidism, is present in at least 30% of patients, as well as reports of hyperparathyroidism.
(two) pathogenesis
There is still debate about the exact pathogenesis of this disease. Theodore initially suspected that the primary abnormality is located in the upper limbal area, and therefore referred to as the upper limbal keratoconjunctivitis. Wright (1972) considered that the upper conjunctiva is the origin of the disease. The stimulating tissue, Donshik et al. (1978) performed a pathological evaluation of the conjunctival specimen. The site of the abnormality was the upper bulbar conjunctiva. Wright (1972) proposed a mechanical hypothesis that the key problem of SLK is the upper conjunctiva and the superior conjunctiva. The continuous friction between the close and the conjunctiva also suggests the effect of mechanical factors.
Patients with chronic inflammation may also develop signs of SLK due to increased friction between the upper conjunctiva and the bulbar conjunctiva. For patients with dry conjunctivitis, there may be a drying effect between the upper palate and the bulbar conjunctiva, thereby increasing Its frictional effect, Wright (1972) speculates that the sacral conjunctiva in chronic inflammation leads to a change in viscosity with the conjunctiva, thereby preventing normal differentiation and replacement of the conjunctival epithelial layer, ultimately leading to the clinical features of SLK. Many treatments, such as the removal of the bulbar conjunctiva or the fixation of the bulbar conjunctiva, can alleviate the symptoms and signs of SLK. These evidences support that the mechanical effect is a causative factor in SLK.
Prevention
Prevention of corneal keratoconjunctivitis above Theodore
The average age of adults with SLK seen between 20 and 60 years old is 49 years old. There are multiple females, and the ratio of male to female is 1:3. No racial tendency or seasonal variation duration and recurrence rate vary from person to person. The disease process can last for weeks, months or years. However, most patients often disappear spontaneously and have little effect on vision. Mostly, the incidence of both eyes (70%). The lesion is mostly symmetrical. 26% to 50% of patients have thyroid dysfunction. A decrease in the Schirmer test in 1/4 of patients has a report of simultaneous SLK in monozygotic twins, suggesting that SLK may have a genetic predisposition.
Complication
Complications of the upper limbal keratoconjunctivitis of Theodore Complications dry keratoconjunctivitis
Another disease associated with SLK is keratoconjunctivitis sicca, which has about one-half of the patients with the initial description of dry keratoconjunctivitis. A summary analysis of reports from seven different cases shows that About 25% of cases are accompanied by dry keratoconjunctivitis.
Symptom
Theodore's upper limbal keratoconjunctivitis symptoms Common symptoms Dreaded and congested eyelids have obvious... Eyelids have foreign body sensation, ptosis, reddened conjunctival papillary hyperplasia, conjunctival hyperemia
SLK patients usually complain of irritating symptoms, foreign body sensation, burning sensation, photophobia, redness, mucous secretions, due to illness time, environment, activity severity, and their symptoms are different, sometimes eyelids and False ptosis, when the filaments spontaneously formed can cause significant discomfort.
The characteristic manifestations of SLK are shown in Table 1. The disease involves the upper conjunctiva, the upper bulbar conjunctiva, the upper limbus and the cornea, the papillary hyperplasia changes in the upper conjunctiva, and the lower conjunctiva has a normal appearance, and the conjunctiva is congested. Thickening, dullness, lesions are often located within 10mm of the center of the upper sclera at 12 o'clock, there is Bengal red staining in the lesion, generally do not use fluorescein or indigo, and occasionally pseudomembranous or subconjunctival hemorrhage The phenomenon.
After staining with fluorescein and bengal red, the upper 1/3 cornea has small epithelial erosion, and 1/3 to 1/2 of SLK patients have multiple filaments in the upper cornea and upper corneal margin. Reports of acquired astigmatism occurred, but astigmatism naturally disappeared after recovery, and Schirmer test revealed a decrease in tear secretion in approximately 1/4 of SLK patients.
Examine
Examination of the keratoconjunctivitis of the upper corner of Theodore
1. Conjunctival smear in the affected area, Gimsa staining can be seen in keratinized epithelial cells, and polymorphonuclear leukocytes can be seen in the upper conjunctiva.
2. Many researchers have studied the histopathology of this disease. Theodore and Ferry (1970) found corneal epithelial keratinization and polymorphonuclear leukocytes in the upper bulbar conjunctiva. Examination showed that the epithelial layer was normal, but polymorphonuclear leukocyte exudation was similar to the bulbar conjunctiva. Theodore also reported the results of biopsy of the upper bulbar conjunctiva and sacral conjunctival tissue. It was found that the superior bulbar conjunctiva had significant keratinization and thickening of the spinous layer. , keratosis and nucleus glomerular degeneration; while the palpebral conjunctiva shows a normal epithelial layer, but with polymorphonuclear leukocytes, lymphocytes and plasma cells infiltrating, Theodore emphasizes the use of Giemsa staining for the upper bulbar conjunctiva to confirm the above characteristics in the disease The importance of diagnosis, in addition, there is a difference in the density of goblet cells in the affected tissue, the upper conjunctiva shows goblet cell hypertrophy, while the upper bulbar conjunctiva shows fewer goblet cells.
Collin et al (1978) performed an electron microscopic study on the conjunctival tissue of SLK patients. In addition to the significant keratinization phenomenon, abnormal distribution and aggregation of nuclear chromatin were also found, which were found in the nucleus of the nucleus and around the nucleus. Filaments, described as "nuclear strangulation", may be a unique phenomenon of SLK, and Donshik et al. (1978) performed light and transmission electron microscopy studies on excised conjunctival specimens, found in the bulbar conjunctiva. There was glycogen accumulation in the cells, and later Wander et al. (1981) found abnormal chromatin condensation in the epithelial smears of the 13 patients studied.
Diagnosis
Diagnosis and differentiation of corneal keratoconjunctivitis above Theodore
diagnosis
The diagnosis of this disease is not difficult. If there is upper conjunctival and corneal staining, especially when there is corneal filament, it can be diagnosed. However, some people believe that because of the certain relationship between this disease and other diseases, it is necessary to diagnose it. Be cautious to avoid the use of certain ineffective and dangerous treatments. The diagnostic criteria are based on characteristic medical history and clinical features. In addition, the scraping of the conjunctiva in the affected area is helpful for diagnosis, Giemsa staining visible angle The epithelial cells, the upper conjunctival smear showed polymorphonuclear leukocytes.
Differential diagnosis
Diseases associated with corneal fibrosis that need to be differentiated include: ptosis, dry keratoconjunctivitis (filament mainly occurs below the cornea), paralytic keratopathy, recurrent corneal erosion, corneal trauma, Neurotrophic keratopathy, herpes simplex keratitis, chronic bullous keratopathy, nystagmus and drug keratitis, except for Sjogren's syndrome, corneal filaments of all these diseases can occur in the cornea any position.
When the cornea has no filaments, the disease should be differentiated from trachoma, superficial punctate keratitis, limbal spring keratoconjunctivitis and blistering keratoconjunctivitis at 12 o'clock. Contact lens-induced keratoconjunctivitis was identified.
