Superior limbic keratoconjunctivitis (SLK, Théodores syndrome) is a disease of the eye characterized by episodes of recurrent inflammation of the superior cornea and limbus, as well as of the superior tarsal and bulbar conjunctiva. It was first described by F. H. Théodore in 1963. Symptoms and signs
Patients present with red eye, burning, tearing, foreign body sensation and mild photophobia. Upon examination, the conjunctiva appears inflamed and thickened, especially at the limbus. Pathophysiology
The development and pathophysiology of SLK is not well understood, but appears to involve microtrauma of keratoconjunctival surfaces. This mechanical hypothesis is supported by the increased lid apposition of exophthalmic thyroid patients, who are known to have an increased incidence of superior limbic keratoconjunctivitis. Diagnosis
Treatment
First-line treatments include topical corticosteroids and artificial tears. For non-responsive cases, potential treatments include topical ciclosporin A, vitamin A, autologous serum and injections of triamcinolone. Surgical treatment options include thermocauterization of the bulbar conjunctiva and conjunctival resection, typically under rose bengal (RB) staining to visualize affected areas. Epidemiology
Superior limbic keratoconjunctivitis tends to occur more often with dry eye syndrome (keratoconjunctivitis sicca), hyperthyroidism and hyperparathyroidism. It is also a rare complication associated with rheumatoid arthritis. Rarely, it may occur as a consequence of upper eyelid blepharoplasty surgery. References


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Possible animal effects
On June 22, 2006, a California brown pelican, possibly under the influence of domoic acid, flew through the windshield of a car on the Pacific Coast Highway. The phycotoxin is found in the local coastal waters. Since March 2007, marine mammal and seabird strandings and deaths off the Southern California coast have increased markedly. These incidents have been linked to the recent and dramatic increase of a naturally occurring toxin produced by algae. Most of the animals found dead tested positive for domoic acid. According to the Channel Islands Marine and Wildlife Institute, "It is generally accepted that the incidence of problems associated with toxic algae is increasing. Possible reasons to explain this increase include natural mechanisms of species dispersal (currents and tides) to a host of human-related phenomena such as nutrient enrichment (agricultural run-off), climate shifts, or transport of algae species via ship ballast water." In popular culture
In the TV series Elementary episode "The Red Team" (original air date January 31, 2013), a witness is intentionally poisoned with domoic acid. In the "Bad Fish" episode of Get a Life (original air date: February 2, 1992), Sharon and Gus get amnesia after eating bad shellfish, and Chris seizes the opportunity to convince them that they are his best friends. Domoic acid poisoning may have caused an August 18, 1961, invasion of thousands of frantic seabirds in Capitola and Santa Cruz, California.