A Case of Conjunctival Lithiasis with Clinical Manifestations of Superior Limbic Keratoconjunctivitis

PURPOSE: To report a case of conjunctival lithiasis with clinical manifestations of superior limbic keratoconjunctivitis. CASE SUMMARY: A 40-year-old male complained of pain, foreign body sensation and injection in the left eye lasting 1 month. The slit-lamp examination revealed injection of the superior bulbar conjunctiva, linear corneal band opacity, fine punctate staining and epithelial defect in the superior cornea area. After eversion of the left upper eyelid, there were many various-sized conjunctional concretions and inflammation in the superior tarsal conjunctiva. Therefore, we considered conjunctival lithiasis-induced clinical manifestations of superior limbic keratoconjunctivitis and then removed the conjunctival concretions using a 30-gauge needle. After the procedures, artificial tears, antibiotic eye drops, steroid eye drops and a therapeutic contact lens were applied. After 1 week, all symptoms and signs improved and there was no recurrence for 4 months. CONCLUSIONS: Mechanical stimulation by severe conjunctival lithiasis can induce clinical manifestations of superior limbic keratoconjunctivitis. Therefore, in patients with clinical manifestations of superior limbic keratoconjunctivitis, conjunctival lithiasis should be considered by observing the superior tarsal conjunctiva more closely.

Two Cases of Superior Limbic Keratoconjunctivitis Treated with Bevacizumab and Triamcinolone Injection

PURPOSE: To report two cases of intractable superior limbic keratoconjunctivitis (SLK) treated with bevacizumab and triamcinolone injection. CASE SUMMARY: A 69-year-old female visited our clinic with pain in the left eye for 3 days and was diagnosed with SLK in her left eye. After 3 months of using steroid eye drops, artificial tears, and oral steroid intermittently, there was no improvement in symptoms and signs, thus this case was considered intractable with the conventional therapy. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 1 week, all symptoms and signs disappeared, and there was no recurrence for 6 months. A 55-year-old female was transferred to our clinic due to SLK that did not respond to artificial tears, steroid eye drops, punctal occlusion, and botox injection for 3 months. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 2 weeks, all symptoms and signs were improved, and there was no recurrence for 4 months. CONCLUSIONS: The presented 2 SLK cases are meaningful, because neovascularization disappeared and controlled inflammation was obtained following sub-tenon injection with both bevacizumab and triamcinolone.

A Case of Conjunctival Lymphangioma With Clinical Manifestations of Superior Limbic Keratoconjunctivitis After Upper Lid Blepharoplasty

PURPOSE: To report a case of conjunctival lymphangioma with clinical manifestations of superior limbic keratoconjunctivitis after upper lid blepharoplasty. CASE SUMMARY: A 55-year-old woman who had upper lid blepharoplasty performed 1 year before complained of pain, injection, and blurred vision in her right eye, which lasted for 2 days. The slit lamp examination revealed a poorly demarcated hypertrophic lesion with central erosion on the superior bulbar conjunctiva and a diffuse corneal erosion and edema in the area of the superior limbus. Tenderness of the superior bulbar conjunctiva and corneal erosion were treated with artificial tears, antibiotic eye drops, and a therapeutic contact lens. Slight anterior chamber reaction was found and treated by steroid eye drops; however, there was no improvement. After eversion of the right upper eyelid with a Desmarres retractor, a hypertrophic lesion with central dimpling was found. However, no exposed sutures were observed. Resection and biopsy of the superior bulbar conjunctiva and a subtarsal triamcinolone injection were performed for diagnosis and treatment. A conjunctival biopsy specimen showed conjunctival lymphangioma. CONCLUSIONS: Conjunctival lymphangioma can occur due to pressure and friction of an eyelid lesion after upper lid blepharoplasty.