LSCD can be genetic (inherited), or caused by a degenerative disease. But it’s more usually caused by a traumatic event, particularly a chemical or heat injury to the eye(s)¹²³ in a domestic or workplace accident, or malicious attack.

Other causes of LSCD include corneal infections, prolonged contact lens wear, eye injury, and diseases of the eye. Prior ocular surgeries or cryotherapies at the limbus may increase susceptibility. Systemic as well as topical chemotherapies may be sufficient to cause deficiency.⁴⁵⁶

Symptoms will vary depending on the cause, but initial symptoms will include decreased vision due to the cornea becoming opaque (conjunctivalisation), neovascularisation, and pain resulting from recurrent erosions. Other symptoms may include contact lens intolerance, sensitivity to light (‘photophobia’), inflammation, tearing, and contraction of the eyelid muscles (‘blepharospasm’).⁷⁸⁹ In later stages, the persistent epithelial defects may lead to ulceration, perforation, build-up of fibrovascular tissue (‘pannus’), and eventually scarring.¹⁰

As some of these symptoms are shared by other eye conditions, it is important to see an ophthalmologist or corneal specialist to obtain an accurate diagnosis. Ocular burns should be monitored by an ophthalmologist to assess whether LSCD is developing.

LSCD can be partial (in which only part of the limbus is involved) or total (in which there are no limbal stem cells left). It can affect only one eye (unilateral) or both (bilateral). A variety of medical and surgical treatment options are available, depending upon the severity of your LSCD and its location in your eye.¹¹¹²

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Someone burning his/her eyes through a chemical accident will most likely receive emergency treatment in a hospital’s Accident and Emergency department. Such treatment will take a stepwise approach, with the aim of stabilising the limbal environment.¹³¹⁴¹⁵

1. This is achieved by stopping the traumatic or toxic injury to the limbus, and by stabilising the surface of the eye by improving the tear film and controlling inflammation. This will include steps such as removing contact lenses, lubricating with preservative-free artificial tears, cleaning the eyelids and applying warm compresses.¹⁶¹⁷¹⁸
2. Ongoing medical management may include nightly topical Vitamin A ointment and short-term pulse topical steroids. Autologous serum eyedrops may stimulate healing of the corneal surface. A “bandage” contact lens or a scleral lens may also be applied to help optimize the health of the ocular surface.¹⁹²⁰

Misdiagnosis can occur, especially during the early stages of the condition. People often see their doctor with symptoms that are not necessarily related to LSCD, as they may be common to many other eye problems associated with an eye injury.²¹

A diagnosis of LSCD requires examination of your eye to see if there are conjunctival changes to the cornea next to the limbus. Such changes are classic symptoms of LSCD.²²²³

As the condition often arises following a chemical or thermal burn, people are often initially seen in Accident and Emergency departments, before being transferred to the care of an ophthalmologist, who will eventually confirm a diagnosis.²⁴

A slit-lamp eye examination under high intensity light will assess the health of your cornea, to see if any conjunctivalisation has occurred.²⁵ A fluorescein staining test can check for abrasions on the cornea.²⁶ In addition to conjunctivalisation,²⁷ the most common signs of LSCD are the formation of new blood vessels (neovascularisation), and scarring.²⁸²⁹

Although diagnosis is typically based on a patient history and the slit-lamp exam, additional diagnostic tests can also help confirm the diagnosis. Corneal impression cytology, in which cellulose paper is applied to the surface of the cornea to take a sample of cells, can provide additional evidence of conjunctivalisation.³⁰ A new imaging technique, known as in vivo confocal microscopy, is a non-invasive way of obtaining information about both superficial and deeper damage to the eye.³¹³²