LACRIMAL PUNCTAL OCCLUSION FOR THE TREATMENT OF SUPERIOR LIMBIC KERATOCONJUNCTIVITIS

PURPOSE: To test the hypothesis that superior limbic keratoconjunctivi tis is caused by insufficient tear supply to the superior keratoconjun ctiva. METHODS: We used cautery and sutures to permanently occlude the lacrimal puncta of 11 patients (22 eyes) with superior limbic keratoc onjunctivitis for whom topical treatment was ineffective. RESULTS: All 11 patients (22 eyes) responded favorably to lacrimal punctal occlusi on. After lacrimal punctal occlusion, rose bengal and fluorescein stai ning (both on a scale of 0 [no staining] to 9 [complete staining]) wer e reduced (mean +/- SD, 2.7 +/- 1.6 to 1.1 +/- 1.8 and 1.4 +/- 1.2 to 0.4 +/- 0.8, respectively). Impression cytology disclosed improvement of squamous metaplasia in the superior conjunctiva as well as increase d goblet cells in nine of 13 eyes (69%) examined. Subjective symptoms improved in all 22 eyes (100%). CONCLUSIONS: Improvement of local tear deficiency to the superior limbic portion by punctal occlusion was an effective treatment in this small series. Superior limbic keratoconju nctivitis might be caused by the insufficient local tear supply.