Chronic complaints of ocular irritation, foreign body sensation, or intermittent redness greater in one eye than the fellow eye may be something as simple as allergic conjunctivitis, dry eye, or blepharitis.
Or, its presence may be indicative of some other ocular disorder that may have significantly different treatments, said Christopher J. Rapuano, MD, chief, Cornea Service, Wills Eye Hospital, and a professor of ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia.
These patients have often seen multiple physicians and been treated with a host of treatments but have yet to show significant improvement in their symptoms.
“This is the type of patient you could see in your office next week,” he said.
In a case example, Dr. Rapuano spoke of a patient who presented with “some blepharitis, some lid thickening,” but nothing that was overtly obvious.
“Lifting the lid, I was a little bit more suspicious,” Dr. Rapuano said, noting there was more redness and inflammation superiorly, and when he had the patient look down, there was evidence of lissamine green staining.
“I did not rub the lissamine green strip on the eye—this was a very, very localized staining of the superior conjunctiva in the patient’s right eye, and a pretty identical superior lissamine green staining in the left eye,” he said.
Flipping the eyelid showed a “velvety pattern under the upper lid,” leading Dr. Rapuano to a diagnosis of superior limbic keratoconjunctivitis (SLK), which can often present in conjunction with dry eye or blepharitis that usually affects middle-aged females (3-5:1 female to male ratio).
