Superior Limbic Keratoconjunctivitis Clinical Presentation

  • Author: James H Oakman Jr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 26, 2011
 

History

The natural history of this condition is prolonged, with gradual clearing, and patients often have seen numerous eye specialists for their symptoms. Unless the doctors have specifically examined the upper bulbar conjunctivae or everted the upper eyelids, the diagnosis may have been previously missed.

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Physical Examination

Symptoms

Patients with superior limbic keratoconjunctivitis (SLK) present with complaints of burning and irritation of the affected eye. Upgaze may elicit these symptoms. Some patients may present with redness.

The symptoms remit and exacerbate and are variable in degree, but no diurnal pattern to the worsening of symptoms exists. Typically, usage of moisturizing medications provides only minimal symptomatic relief. In most cases, the condition is present bilaterally, although one eye may be more symptomatic.

Patients with corneal filaments are usually extremely symptomatic, which may distract the examiner from the underlying condition.

Commonly, a history of thyroid dysfunction is elicited upon questioning.

Signs

Marked inflammation of the upper lid tarsal conjunctiva, adjacent inflammation of the upper bulbar conjunctiva, and punctate rose Bengal staining of the cornea at the upper limbus are signs of superior limbic keratoconjunctivitis.

The conjunctiva extending from the upper limbus to the insertion of the superior rectus muscle also demonstrates thickening, hyperemia, and typical rose Bengal staining. This finding stands out in stark contrast to the normal appearance of the inferior conjunctiva and cornea.

Approximately one third of patients present with filaments on the upper cornea or along the superior limbus.

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Contributor Information and Disclosures
Author

James H Oakman Jr, MD  Partner, Southern Eye Center, Augusta, Georgia

James H Oakman Jr, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association of American Physicians and Surgeons, Georgia Medical Society, Georgia Society of General Surgeons, and Georgia Society of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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