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Recharacterization of superior limbic keratoconjunctivitis via a subdividing grading method in 236 Chinese patients

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Abstract

Purpose

Superior limbic keratoconjunctivitis (SLK) is an uncommon and often overlooked chronic ocular surface disease. This retrospective consecutive case series study on Chinese patients aimed to characterize the features of this disease, including those undescribed in previous literature.

Methods

Two hundred thirty-six patients diagnosed with SLK were enrolled into this consecutive case study from 2016 to 2019. The demographics, symptoms, Ocular Surface Disease Index, and ocular signs were collected and analyzed. A scoring system (SLK scale index, SSI) that integrated five major sign scores was applied to evaluate SLK severity.

Results

Of the 236 SLK patients, dryness was the most common complaint (59.3%). Of 459 SLK eyes, superior limbus/conjunctival staining (SCS) was present in 98% eyes, followed by the superior tarsal conjunctival alterations (85.2%) and superior bulbar conjunctiva hyperemia (80.8%). Approximately 63% of eyes were accompanied by corneal staining. Superior bulbar conjunctivochalasis was a relatively rare sign (41.6%). Among the five major signs, only the prevalence of SCS gradually increased with its severity. In addition, fluorescein staining at the inferior limbus and adjacent conjunctiva (ICS) was found positive in 163 eyes of 84 patients (36%) who had significantly higher SSI than those without ICS (p = 0.013).

Conclusions

We found that SCS is the most common out of the 5 typical signs of SLK. ICS, a new sign, occurred in one-third of patients. SCS, a simple marker of SLK, as well as SSI, an integrated evaluation system, had the advantage of evaluating the severity and objectively characterizing SLK in clinical practice.

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Data availability

All data and materials support our published claims and comply with field standards.

Code availability

Not applicable.

Abbreviations

SLK:

Superior limbic keratoconjunctivitis

SCS:

Conjunctival staining at the superior conjunctiva and limbus

SCH:

Superior bulbar conjunctiva hyperemia

SBC:

Superior bulbar conjunctivochalasis

CS:

Cornea staining

TCP:

Papillary hypertrophy and hyperemia of the superior tarsal conjunctiva

ICS:

Fluorescein staining at the inferior limbus and adjacent conjunctiva

SSI:

SLK scale index

OSDI:

Ocular Surface Disease Index©

BCVA:

Best-corrected visual acuity

IOP:

Intraocular pressure

logMAR:

Logarithm of minimal angle of resolution

TBUT:

Tear break-up time

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Funding

This work was supported by grants from the Guangzhou Science Technology and Innovation Commission (201607020011) and the National Natural Science Foundation of China (81770896, 81970848).

Author information

Author notes

  1. Chao Cheng and Minyi Zhu contributed equally as co-first authors.

Authors and Affiliations

  1. Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China

    Chao Cheng, Minyi Zhu, Tianlan Lin, Ziyan Chen, Weiting Zeng, Kunke Li, Ran Xue, Fang Duan & Kaili Wu

  2. Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, People’s Republic of China

    Minyi Zhu

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  1. Chao Cheng
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Contributions

Conceptualization: Kaili Wu, Chao Cheng, Minyi Zhu; methodology: Chao Cheng, Minyi Zhu; formal analysis and investigation: Chao Cheng, Minyi Zhu, Tianlan Lin, Ziyan Chen, Weiting Zeng, Kunke Li, Ran Xue, Fang Duan; writing (original draft preparation): Chao Cheng; writing (review and editing): Kaili Wu; funding acquisition: Kaili Wu; supervision: Kaili Wu.

Corresponding author

Correspondence to Kaili Wu.

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Ethics approval

Ethics approval was obtained before the procedures adhered to the tenets of the 1964 Declaration of Helsinki. Protocols were approved by the Institutional Ethics Committee of Zhongshan Ophthalmic Center (approval ID: 2014MEKY013, 2018KYPJ140, Medical Ethics Committee, Sun Yat-sen University, Guangzhou, China).

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Informed consent was obtained from all individual participants included in the study.

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Cheng, C., Zhu, M., Lin, T. et al. Recharacterization of superior limbic keratoconjunctivitis via a subdividing grading method in 236 Chinese patients. Graefes Arch Clin Exp Ophthalmol 260, 2291–2298 (2022). https://doi.org/10.1007/s00417-022-05575-z

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