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    Lifeless limbus: What's the diagnosis?

    Soft contact lens-induced limbal stem cell deficiency commonly misdiagnosed; has serious complications if left untreated

    By Amelia Fong, MD

    Editor’s Note: Ophthalmology Times is pleased to announce Amelia Fong, MD, of Georgetown University School of Medicine, Washington, DC, as the third-place winner of the publication’s 2015 Resident Writer’s Award Program, sponsored by Allergan. Dr. Fong’s entry is featured here.

    The Ophthalmology Times Resident Writer’s Award Program is a unique recognition opportunity designed to promote excellence in ocular surface disease education. It was created to acknowledge outstanding case identification and written presentation skills in ophthalmology residents.

    Amy Patel, MD, of Gavin Herbert Eye Institute, UC Irvine Health, Irvine, CA, is the first-place winner of this year’s Resident Writer’s Award Program. Dr. Patel’s winning submission—“There’s something in the water”—is featured hereSeanna Grob, MD, MAS, of Massachusetts Eye and Ear, Harvard Medical School, Boston, is the second-place winner. Dr. Grob’s entry—“Management of drug-induced cicatricial conjunctivitis and dry eye”—is featured here.To read all of the case study submissions from this year’s Ophthalmology Times Resident Writer’s Award Program, click here.

    A 67-year-old African American male presented to the ophthalmology clinic after referral from an outside optometrist. He was seen previously for a 4-month history of red eye by two outside optometrists, diagnosed with filamentary keratitis, and given tobramycin/dexamethasone ophthalmic suspension 0.3%/0.05%.

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    His medical history was significant for hypertension and a history of prostate cancer. His medications included hypertensive medicines and aspirin.

    He denied any ocular history except soft contact lens wear for the past 24 years with average daily wear of 12 to 16 hours a day.

    He denied any ocular insult, did not use eye drops prior to presentation to the optometrist, or any family history of ocular diseases. He gave no history of severe allergic reactions, rash, autoimmune diseases, radiation, or any other cancers.

    Examination

    At the time of presentation, ocular examination showed a best-corrected visual acuity of 20/30 in both eyes with ability to pinhole down to 20/20 in the right eye and 20/25 in the left. Pupils, motility, and IOP were unremarkable. Anterior examination revealed pannus superiorly and 1+ guttae in both eyes.

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    In the left eye, opaque epithelium arising from the superior limbus was observed to cover the visual axis and involve 70% of the cornea. Similar findings were present to a lesser degree in the right eye.

    Late-fluorescein staining with a “whorl-like” pattern was demonstrated in both eyes. Dilated fundoscopic examination was unremarkable bilaterally.

    Discussion and diagnosis

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