It has also been postulated that further frictional forces can lead to microtrauma which may be significant enough to cause pathology in the conjunctiva such as conjunctival folds or superior limbic keratoconjunctivitis. 5 , 6 Frictional forces may be generated if there is disruption of the tear film, surface quality, difference in load between different layers within the eye, and altered lid dynamics. 5
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