Purpose. To describe a group of patients with limbal stem cell (SC) de
ficiency without prior diagnosis of a specific disease entity known to
be causative of SC deficiency. Methods. We performed a retrospective
review of the records of all patients with ocular surface disease seen
at the University of Minnesota between 1987 and 1996. Patients were c
ategorized according to origin of limbal deficiency. Patients who did
not have a specific diagnosis previously described as being causative
of limbal deficiency were analyzed. Risk factors, clinical findings, a
nd sequelae were evaluated. Results. Fourteen eyes of 12 patients with
SC deficiency not caused by a known diagnosis were described. All eye
s had prior ocular surgery involving the corneoscleral limbus. Eleven
eyes had been receiving long-term topical medications, and all eyes ha
d concurrent external disease such as pterygium, keratoconjunctivitis
sicca, rosacea, herpes simplex virus keratitis, or aphakic or pseudoph
akic corneal edema. All eyes had superior quadrants affected, correspo
nding to areas of prior limbal surgery. Sequelae of disease included c
orneal scarring and neovascularization, with seven eyes having visual
acuity of 20/150 or worse. Conclusion. Because the epitheliopathy star
ted peripherally and extended centrally in all patients, we believe it
represents an SC deficiency. The fact that all patients were affected
superiorly, at sites of a prior limbal surgical incision, points to s
urgical trauma to the SC as the likely major etiologic factor for the
deficiency. The surgical trauma to the limbal SC probably made these c
ells more susceptible to damage from other external disease influences
and toxicity from long-term topical medications. Because the SC defic
iency is the result of prior ocular surgery and long-term topical medi
cations, we propose the term ''iatrogenic limbal stem cell deficiency.
''.