Limbal Stem Cell Deficiency -- by Roxanne A. Achong, OD

Title

Limbal Stem Cell Deficiency

Author

Roxanne A. Achong, OD

Purpose

Limbal stem cells are responsible for the homeostasis of the corneal epithelium and are the origin of cell lineage.

Methods

A case of limbal stem cell deficiency is presented along with a review of various etiologies and current management strategies.

Case Report

A 38 year old 20 year soft contact lens wearer presented with a red itchy eye with discharge. Superficial punctate keratitis was observed OU with pannus 1mm on the superior left cornea. Six months later her visual acuity had reduced to 20/40 in the affected eye. The corneas showed slight haze OU with epithelial microcysts OS>OD. A redundant triangular fold of epithelium was observed over the superior limbus in the left eye. Irregular corneal; astigmatism resulted. The differential diagnosis of limbal stem cell deficiency include Superior Limbic Keratoconjunctivitis and advancing wave-like epitheliopaythy.

Discussion

The mechanism of limbal stem cell deficiency is unknown but may occur from aplasia associated with Steven's-Johnson syndrome, chemical/thermal burns, iatrogenic causes, contact lens wear and microbial keratitis. A lack of stromal support as occurs in aniridia, multiple endocrine deficiencies, neurotrophic keratopathy, peripheral inflammatory keratopathy, limbitis has also been observed.

The initial treatment is supportive such as artificial tears and discontinuation of the presumed source in this case contact lens wear. Occasionally surgical alternatives such as limbal autograft transplantation, keratoepithelioplasty and amniotic membrane transplant.