Four years ago, at the age of 54, I developed what was later diagnosed by my ophthalmologist as "superior limbic keratoconjunctivitis." I have tried all types of lubricating drops, which do not help much. Silver nitrate treatment did not help either. Is there any other treatment?

M.

Superior limbic keratoconjunctivitis (SLK) is a disease of unknown cause that causes recurring inflammation of the conjunctiva, which is the outermost coating of the whites of one's eyes. Specifically, in SLK, the conjunctiva under the upper eyelid becomes inflamed.

Most people with SLK will experience eye pain, burning and sensitivity to light. Lifting the upper eyelid will reveal redness of the upper conjunctiva. Since there are many causes of eye redness, only an ophthalmologist can determine whether a person with red eyes has SLK or another process such as viral conjunctivitis or ocular allergies.

SLK affects mostly women between the ages of 35-55 and is often seen in both eyes. About 50 percent of people with SLK have an underlying thyroid dysfunction, so it is very important that you see a doctor to check for such problems.

SLK episodes can last anywhere from one to 10 years. Eventually, the condition does resolve on its own, but treatment can be effective at eliminating the symptoms more quickly. Since no one knows the exact cause of SLK, current methods of treatment are aimed at removing the outermost coating of the conjunctiva. Techniques include surgical removal, cautery (heat) or chemotherapy (silver nitrate). However, even with treatment, SLK often recurs. Topical anti-inflammatory medications have not been found to be helpful in controlling symptoms. Lubricating drops can provide mild relief but will not eliminate the symptoms completely.

For an SLK patient, such as yourself, who has already undergone chemical treatment with silver nitrate, options include surgery or cautery. Occasionally, a large, soft contact lens that covers the superior conjunctiva can also provide relief.