J Korean Ophthalmol Soc.  2016 Jun;57(6):983-987. 10.3341/jkos.2016.57.6.983.

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

• Son BK
• Yang CM
• Kim TG
• Jin KH

• KMID: 2290503
• DOI: http://doi.org/10.3341/jkos.2016.57.6.983

Abstract

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.

Keyword

Conjunctival lithiasis; Superior limbic keratoconjunctivitis

MeSH Terms

Adult
Conjunctiva
Cornea
Eyelids
Foreign Bodies
Humans
Inflammation
Keratoconjunctivitis*
Lithiasis*
Lubricant Eye Drops
Male
Needles
Ophthalmic Solutions
Recurrence
Sensation
Lubricant Eye Drops
Ophthalmic Solutions

Figure

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  Figure 1. Slit lamp photographs of the left eye at initial presentation. There are superior sectoral bulbar conjunctival injection (arrow) (A), a linear corneal band opacity (arrow) (B), a fine punctate staining and epithelial defect (arrow) (C). Multiple vari-ous-sized concretions and Inflammation are observed on the superior tarsal conjunctiva (arrow) (D).

• 

  Figure 2. Slit lamp photographs of the right eye at initial presentation. There is no specific abnormalities in the cornea and conjunctiva (A). Very few concretions are observed on the superior tarsal conjunctiva (arrow) (B).

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  Figure 3. Slit lamp photographs of the left eye at 4 months. Superior bulbar conjunctival injection disappeared (arrow) (A). A linear band opacity (arrow) (B), punctate epithelial erosions improved and epithelial defect completely recovered (arrow) (C). Most of concretions were eliminated and inflammation resolved on the superior tarsal conjunctiva (arrow) (D).

Reference

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