title: Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis.
abstract: OBJECTIVE
  To test the hypothesis that superior limbic keratoconjunctivitis is caused by insufficient tear supply to the superior keratoconjunctiva.
  
  
  METHODS
  We used cautery and sutures to permanently occlude the lacrimal puncta of 11 patients (22 eyes) with superior limbic keratoconjunctivitis for whom topical treatment was ineffective.
  
  
  RESULTS
  All 11 patients (22 eyes) responded favorably to lacrimal punctal occlusion. After lacrimal punctal occlusion, rose bengal and fluorescein staining (both on a scale of 0 [no staining] to 9 [complete staining]) were 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 increased 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 keratoconjunctivitis might be caused by the insufficient local tear supply.
authors.affiliation: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
authors.forename: H Y
authors.initials: HY
authors.lastname: Yang
authors.forename: H
authors.initials: H
authors.lastname: Fujishima
authors.forename: I
authors.initials: I
authors.lastname: Toda
authors.forename: J
authors.initials: J
authors.lastname: Shimazaki
authors.forename: K
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000328:Adult; D000368:Aged; D002425:Cautery / Q000379:methods; D005260:Female; D019793:Fluorescein; D005452:Fluoresceins; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006801:Humans; D007637:Keratoconjunctivitis / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D007765:Lacrimal Apparatus / Q000378:metabolism / Q000601:surgery*; D007767:Lacrimal Duct Obstruction / Q000209:etiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012395:Rose Bengal; D013536:Suture Techniques; D013666:Tears / Q000378:metabolism
chemical_list: D005452:Fluoresceins; D005456:Fluorescent Dyes; D012395:Rose Bengal; D019793:Fluorescein