A 45-year-old woman with easy fatigability and heat intolerance has bilateral ocular irritation worse on awakening, redundant lax conjunctiva above the upper cornea, fine filamentary keratopathy, and dense rose bengal staining of the superior bulbar conjunctiva. The underlying systemic association is:
- A Hyperthyroidism due to Graves disease ✓
- B Rheumatoid arthritis with secondary Sjogren syndrome
- C Systemic sclerosis with CREST features
- D Sarcoidosis with lacrimal gland infiltration
Correct answer: A. Hyperthyroidism due to Graves disease
Explanation
Superior limbic keratoconjunctivitis of Theodore affects the superior limbus and superior bulbar conjunctiva, producing inflammation, redundant folds, filaments, and superior rose bengal staining. It is strongly associated with thyroid dysfunction, most commonly hyperthyroidism of Graves disease, found in a substantial proportion of patients. Rheumatoid arthritis and sarcoidosis cause aqueous-deficient dry eye with diffuse staining, not the strictly superior distribution seen here.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.