A 40-year-old woman complains of foreign body sensation and burning in both eyes, worse late in the day. Examination shows sectoral injection and thickening of the superior bulbar conjunctiva with redundant folds that move with the upper lid, plus fine filaments on the superior cornea. Rose bengal stains the affected zone. Which systemic association should be sought?

• A Thyroid dysfunction ✓
• B Rheumatoid arthritis
• C Sarcoidosis
• D Coeliac disease

Explanation

This is superior limbic keratoconjunctivitis of Theodore: superior bulbar hyperaemia, thickening and redundancy of the conjunctiva, superior filamentary keratitis, and rose bengal staining of the involved sector. Roughly a third of patients have an associated thyroid disorder, most commonly Graves disease, so thyroid function must be tested. Rheumatoid arthritis is linked to dry eye and peripheral ulcerative keratitis, not to this distinctive superior sectoral picture.

Reference: Yanoff and Duker, Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.