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Conjunctival fixation sutures for refractory superior limbic keratoconjunctivitis

A 75-year-old Japanese woman was referred to us for persistent irritation in September 2006. She reported a history of foreign-body sensation in the left eye for 4 years. Slit-lamp examination revealed hypertrophy, hyperaemia and pronounced fluorescein staining of the superior bulbar conjunctiva in the left eye (fig 1A,B). Schirmer test results were 2 mm in the right eye and 1 mm in the left eye. The diagnosis of superior limbic keratoconjunctivitis (SLK) with aqueous deficiency dry eye was made based on these findings. Initially, treatment was attempted with 0.1% fluorometholone and 0.1% sodium hyaluronate eye-drops without success. Punctal plugs inserted to the upper and the lower puncta provided little symptomatic relief.



Figure 1 
Before surgery, hyperaemia and hypertrophic changes are seen in the superior bulbar conjunctiva (A). The affected area is intensively stained with fluorescein sodium (B). Two weeks after the operation, marked improvements in hyperaemia and fluorescein staining are apparent (C, D).



We applied fixation sutures to the superior bulbar conjunctiva in December 2006 to attempt to treat this refractory condition. First, the patient received a topical and subconjunctival injection of lidocaine 2%. A traction suture was made by placing a 6–0 silk suture at the limbus at the 12 o’clock position, so as to rotate the eye downward (fig 2). Stretching the redundant superior bulbar conjunctiva with a spatula, anchoring sutures were then placed using 10–0 nylon sutures at a location 10–12 mm from the limbus to …