A Case of Idiopathic T-cell Mediated Chronic Conjunctivitis With Limbitis Treated Using Oral Cyclosporine

Jung Hyun Park; Won Ryang Wee; Jin Hak Lee; Mee Kum Kim

doi:10.3341/jkos.2007.48.11.1567

Journal List > J Korean Ophthalmol Soc > v.48(11) > 1007972

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Park, Wee, Lee, and Kim: A Case of Idiopathic T-cell Mediated Chronic Conjunctivitis With Limbitis Treated Using Oral Cyclosporine

Original Article

J Korean Ophthalmol Soc 2007;48(11):1567-1572.

Published online: 28 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.11.1567

A Case of Idiopathic T-cell Mediated Chronic Conjunctivitis With Limbitis Treated Using Oral Cyclosporine

Jung Hyun Park, M.D.¹, Won Ryang Wee, M.D., Ph.D.^1,², Jin Hak Lee, M.D. Ph.D.^1,², Mee Kum Kim, M.D., Ph.D.^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Clinical Research Institute, Seoul National University Hospitaf, Seoul, Korea

Address reprint requests to Mee Kum Kim, M.D., Ph.D., Department of Ophthalmology, Seoul National University College of Medicine, #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea, Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: kmk9@snu.ac.kr

Received 14 December 2006 Accepted 24 July 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of refractory idiopathic T cell mediated chronic conjunctivitis causing limbal insufficiency, which improved with cyclosporine therapy.

Case Summary

A 43-year old man complained of conjunctival injection and discomfort in both eyes that lasted three years and was refractory to topical steroids, antibiotics, and artificial tears. There was no evidence of connective tissue diseases, Stevens-Johnson syndrome, pemphigoid, or drug history. Both eyes presented with diffuse injection and thickening of the conjunctiva, punctuated epithelial erosion of the conjunctiva and cornea, severe limbal epithelitis and elevated intraocular pressure. The left cornea was conjunctivalized due to limbal deficiency. Histological examination revealed severe infiltration of T and B cells, without any evidence of tumor cells or basement membrane anomaly. When treated with oral cyclosporine, injection and thickening of the conjunctiva decreased and the intraocular pressure was normalized. The surface inflammation of both eyes completely resolved two months after the treatment was initiated.

Conclusions

In chronic idiopathic conjunctivitis with limbitis resistant to conventional treatment and T cell infiltration found in pathological examination, oral cyclosporine therapy might be required to resolve inflammation.

Keywords: Conjunctivitis, Limbitis, Cyclosporine, T cell

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Figure 1.

Conjunctival thickening, diffuse limbitis and diffuse punctuate epithelial erosion of the conjunctiva and cornea in the right eye (A and B). In the left eye, (C and D) conjunctivalization and diffuse limbal deficiency were accompanied with diffuse limbitis and conjunctivitis.

Figure 2.

The H&E staining (A) shows chronic inflammation with lymphoid cell infiltration, but there was no infiltration in the basement membrane or malignant cells. The immunohistochemistry staining against CD3 (B) and L26 (C) shows infiltration of T and B lymphocytes in the stroma. (×100)

Figure 3.

The conjunctival inflammation completely subsided in both eyes 10 weeks after he was treated with oral cyclosporine. The cornea became clear in the right eye (A and C) but the left eye showed stromal opacity and limbal neovascularization due to limbal insufficiency (B and D).

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