Limbal stem cell deficiency (LSCD) occurs when there is sufficient disturbance or destruction of the limbal stem cells of the corneal epithelium, resulting in disruption of the normal physiologic regenerative process and repopulation of corneal epithelium. Subsequently, LSCD may result in epithelial irregularities including erosions, ulcerations, neovascularization, and potentially conjunctivalization of the corneal surface in advanced cases. Classically, a "whorled" appearance of the corneal surface may be seen on exam, resulting from the centripetal extension of epithelium from the limbus as seen here extending from the superior limbus.
This patient presented with signs and symptoms of vernal keratoconjunctivitis (VKC) with stem cell deficiency (LSCD). LSCD is characterized by a loss or dysfunction of the limbal epithelial stem cells, which are critical for the maintenance and regeneration of the corneal epithelium. In the setting of VKC, chronic inflammation and mechanical trauma from persistent eye rubbing can result in progressive damage to the limbal stem cell niche. This leads to conjunctivalization of the corneal surface, evidenced by epithelial haze, superficial vascularization, and a whorl-like epitheliopathy.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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