Limbal Stem Cell Deficiency & Ocular Surface Rehabilitation

What do limbal stem cells do?

At the limbus — the border between the clear cornea and the white of the eye — sits a reservoir of stem cells that continuously regenerate the corneal epithelium. They also form a barrier that prevents the conjunctiva from growing over the cornea.

What happens in limbal stem cell deficiency (LSCD)?

When these cells are lost — most dramatically after chemical or thermal burns, but also through severe ocular surface inflammation (e.g. Stevens-Johnson syndrome), chronic contact-lens-related stress, multiple surgeries or congenital causes — the corneal surface cannot renew itself. The conjunctiva grows across the cornea (conjunctivalisation), causing chronic redness, poor healing, irregular surface, scarring and severely reduced vision.

How LSCD is diagnosed

The clinical picture — a whorled, irregular, staining corneal surface with conjunctival overgrowth — is usually recognisable at the slit lamp; impression cytology can confirm it. Equally important is assessing the tear film, eyelids and inflammation, because these determine whether any transplant can succeed.

Treatment concepts

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• Partial disease: optimise the tear film and surface medically; sometimes remove the conjunctivalised tissue and allow the remaining limbus to recover.
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• Total disease, one eye affected: transplant healthy limbal tissue from the patient's other eye (autologous), which avoids rejection.
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• Both eyes affected: tissue from a living relative or a deceased donor (allogeneic), usually requiring long-term anti-rejection medication.
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• SLET (Simple Limbal Epithelial Transplantation): a technique in which tiny pieces of limbal tissue are distributed on the corneal surface over a membrane scaffold, where they expand and re-epithelialise the eye. It uses very little donor tissue and avoids laboratory cell culture.
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Any limbal transplantation requires the ocular surface environment — lids, tears, inflammation — to be corrected first, and suitability can only be judged by specialist examination. Corneal transplantation for vision is considered separately, usually after the surface has been stabilised.

Research context

Dr. Shraddha Sureka has contributed to clinical research relating to limbal epithelial transplantation, in work guided by Dr. Virendra Sangwan — the clinician-scientist associated with developing SLET — during her cornea training. Details of her academic work appear on the research page as publications are verified.

Information on this page is for general education and does not replace an examination, diagnosis or personalised medical advice from a qualified eye-care professional.

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