Treatment of superior limbic keratoconjunctivitis with a large-diameter contact lens and Botulium Toxin A

Cornea. 2009 Aug;28(7):752-8. doi: 10.1097/ICO.0b013e3181967006.


Purpose: To evaluate the effect of a large-diameter (16-20 mm) hydrogel contact lens (CL) or an injection of Botulinum Toxin A to Riolan muscle for the treatment of superior limbic keratoconjunctivitis (SLK).

Methods: Eight eyes from 8 patients were fitted with large-diameter CL for 7 days. The clinical improvement and changes of fluorescein and rose bengal staining were examined on the day of diagnosis and 3, 7, 14, and 30 days after the CL was fitted. Three eyes showing symptoms of recurrence of SLK within 1 month after removal of the CL and 2 eyes with complications related to CL were treated with an injection of Botulinum Toxin A to pretarsal orbicularis muscle, Riolan. The changes of symptoms and vital stains were also evaluated on day 7 and 1, 2, 3, and 6 months after the injection.

Results: The mean age was 48 +/- 13.5 years, and the group consisted of 6 females and 2 males. Dry eye syndrome and horizontal conjunctival corrugation were found in all 8 patients, superior conjunctivochalasis in 5 patients, and floppy eyelid syndrome in 2 patients. Complete resolution after more than 1 month with CL only was seen in 3 eyes (37.5%). Clinical symptoms improved in 4.62 days and vital staining in 10.75 days after fitting of the CL. Superficial punctuate keratopathy related to CL occurred in 3 eyes (37.5%). Five eyes (62.5%) that were treated with botulinum showed distinct improvement within 7 days after the injection, and the effect was maintained for 2-7 months.

Conclusions: The fitting of large-diameter CL can be considered for the treatment of acute severe symptoms of SLK for a short time. An injection of Botulinum toxin to the Riolan muscle can effectively and rapidly resolve the symptoms associated with SLK, and its effect of maintenance was a mean of 4 months.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Botulinum Toxins, Type A / administration & dosage*
  • Contact Lenses*
  • Female
  • Fluorescent Dyes
  • Humans
  • Injections, Intramuscular
  • Keratoconjunctivitis / diagnosis
  • Keratoconjunctivitis / drug therapy
  • Keratoconjunctivitis / physiopathology
  • Keratoconjunctivitis / therapy*
  • Male
  • Middle Aged
  • Neuromuscular Agents / administration & dosage*
  • Oculomotor Muscles / drug effects*
  • Prosthesis Fitting


  • Fluorescent Dyes
  • Neuromuscular Agents
  • Botulinum Toxins, Type A