Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Superior Limbic Keratoconjunctivitis Clinical Presentation

  • Author: James H Oakman, Jr, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Apr 23, 2015
 

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.

Next

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.

Previous
 
 
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: Association of American Physicians and Surgeons, Georgia Medical Society, Georgia Society of Ophthalmology, Georgia Society of the American College of Surgeons, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

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: Received salary from Medscape for employment. for: Medscape.

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 Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References
  1. Thygeson P, Kimura SJ. Chronic conjunctivitis. Trans Am Acad Ophthalmol Otolaryngol. 1963 Jul-Aug. 67:494-517. [Medline].

  2. Tenzel RR. Comments on superior limbic filamentous keratitis: II. Arch Ophthalmol. 1968 Apr. 79(4):508. [Medline].

  3. Corwin ME. Superior limbic keratoconjunctivitis. Am J Ophthalmol. 1968 Aug. 66(2):338-40. [Medline].

  4. Smolin G, Thoft RA. Superior limbic keratoconjunctivitis. In: Ostler HB, ed. The Cornea. 2nd ed. 1987. 1:296-9.

  5. Stenson S. Superior limbic keratoconjunctivitis associated with soft contact lens wear. Arch Ophthalmol. 1983 Mar. 101(3):402-4. [Medline].

  6. Cher I. Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis. Clin Experiment Ophthalmol. 2000 Jun. 28(3):181-4. [Medline].

  7. Sheu MC, Schoenfield L, Jeng BH. Development of superior limbic keratoconjunctivitis after upper eyelid blepharoplasty surgery: support for the mechanical theory of its pathogenesis. Cornea. 2007 May. 26(4):490-2. [Medline].

  8. Cher I. Blink-related microtrauma: when the ocular surface harms itself. Clin Experiment Ophthalmol. 2003 Jun. 31(3):183-90. [Medline].

  9. Matsuda A, Tagawa Y, Matsuda H. TGF-beta2, tenascin, and integrin beta1 expression in superior limbic keratoconjunctivitis. Jpn J Ophthalmol. 1999 Jul-Aug. 43(4):251-6. [Medline].

  10. Matsuda A, Tagawa Y, Matsuda H. Cytokeratin and proliferative cell nuclear antigen expression in superior limbic keratoconjunctivitis. Curr Eye Res. 1996 Oct. 15(10):1033-8. [Medline].

  11. Saika S, Minamide A, Tanaka T, et al. Expression of involucrin by ocular surface epithelia of patients with benign and malignant disorders. Curr Eye Res. 2000 Nov. 21(5):877-85. [Medline].

  12. Sun YC, Hsiao CH, Chen WL, Hu FR. Overexpression of matrix metalloproteinase-1 (MMP-1) and MMP-3 in superior limbic keratoconjunctivitis. Invest Ophthalmol Vis Sci. 2011 May. 52(6):3701-5. [Medline].

  13. Kojima T, Matsumoto Y, Ibrahim OM, Sato EA, Dogru M, Tsubota K. In vivo evaluation of superior limbic keratoconjunctivitis using laser scanning confocal microscopy and conjunctival impression cytology. Invest Ophthalmol Vis Sci. 2010 Aug. 51(8):3986-92. [Medline].

  14. Sun YC, Hsiao CH, Chen WL, et al. Conjunctival resection combined with tenon layer excision and the involvement of mast cells in superior limbic keratoconjunctivitis. Am J Ophthalmol. 2008 Mar. 145(3):445-452. [Medline].

  15. Udell IJ, Kenyon KR, Sawa M, et al. Treatment of superior limbic keratoconjunctivitis by thermocauterization of the superior bulbar conjunctiva. Ophthalmology. 1986 Feb. 93(2):162-6. [Medline].

  16. Fraunfelder FW. Liquid nitrogen cryotherapy of superior limbic keratoconjunctivitis. Am J Ophthalmol. 2009 Feb. 147(2):234-238.e1. [Medline].

  17. Kojima T, Higuchi A, Goto E, Matsumoto Y, Dogru M, Tsubota K. Autologous serum eye drops for the treatment of dry eye diseases. Cornea. 2008 Sep. 27 Suppl 1:S25-30. [Medline].

  18. Chun YS, Kim JC. Treatment of superior limbic keratoconjunctivitis with a large-diameter contact lens and Botulium Toxin A. Cornea. 2009 Aug. 28(7):752-8. [Medline].

  19. Shen YC, Wang CY, Tsai HY, et al. Supratarsal triamcinolone injection in the treatment of superior limbic keratoconjunctivitis. Cornea. 2007 May. 26(4):423-6. [Medline].

  20. Kymionis GD, Klados NE, Kontadakis GA, Mikropoulos DG. Treatment of superior limbic keratoconjunctivitis with topical tacrolimus 0.03% ointment. Cornea. 2013 Nov. 32(11):1499-501. [Medline].

  21. Passons GA, Wood TO. Conjunctival resection for superior limbic keratoconjunctivitis. Ophthalmology. 1984 Aug. 91(8):966-8. [Medline].

  22. Kheirkhah A, Casas V, Esquenazi S, et al. New surgical approach for superior conjunctivochalasis. Cornea. 2007 Jul. 26(6):685-91. [Medline].

  23. Donshik PC, Collin HB, Foster CS, et al. Conjunctival resection treatment and ultrastructural histopathology of superior limbic keratoconjunctivitis. Am J Ophthalmol. 1978 Jan. 85(1):101-10. [Medline].

  24. Goto E, Shimmura S, Shimazaki J, et al. Treatment of superior limbic keratoconjunctivitis by application of autologous serum. Cornea. 2001 Nov. 20(8):807-10. [Medline].

  25. Yang HY, Fujishima H, Toda I, et al. Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis. Am J Ophthalmol. 1997 Jul. 124(1):80-7. [Medline].

  26. Mondino BJ, Zaidman GW, Salamon SW. Use of pressure patching and soft contact lenses in superior limbic keratoconjunctivitis. Arch Ophthalmol. 1982 Dec. 100(12):1932-4. [Medline].

  27. Watson S, Tullo AB, Carley F. Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. Br J Ophthalmol. 2002 Apr. 86(4):485-6. [Medline].

  28. Gris O, Plazas A, Lerma E, Güell JL, Pelegrín L, Elíes D. Conjunctival resection with and without amniotic membrane graft for the treatment of superior limbic keratoconjunctivitis. Cornea. 2010 Sep. 29(9):1025-30. [Medline].

  29. Ahn JM, Choi CY, Seo KY. Surgical approach with high-frequency radiowave electrosurgery for superior limbic keratoconjunctivitis. Cornea. 2014 Feb. 33(2):210-4. [Medline].

  30. Sahin A, Bozkurt B, Irkec M. Topical cyclosporine a in the treatment of superior limbic keratoconjunctivitis: a long-term follow-up. Cornea. 2008 Feb. 27(2):193-5. [Medline].

  31. Confino J, Brown SI. Treatment of superior limbic keratoconjunctivitis with topical cromolyn sodium. Ann Ophthalmol. 1987 Apr. 19(4):129-31. [Medline].

  32. Grutzmacher RD, Foster RS, Feiler LS. Lodoxamide tromethamine treatment for superior limbic keratoconjunctivitis. Am J Ophthalmol. 1995 Sep. 120(3):400-2. [Medline].

  33. Moshirfar M, Khalifa YM, Kuo A, Davis D, Mamalis N. Ocular surface squamous neoplasia masquerading as superior limbic keratoconjunctivitis. Middle East Afr J Ophthalmol. 2011 Jan. 18(1):74-6. [Medline]. [Full Text].

  34. Ohashi Y, Watanabe H, Kinoshita S, et al. Vitamin A eyedrops for superior limbic keratoconjunctivitis. Am J Ophthalmol. 1988 May 15. 105(5):523-7. [Medline].

  35. Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al. Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis. Ophthalmology. 2003 Aug. 110(8):1578-81. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.