eMedicine Specialties > Ophthalmology > Cornea

Keratoconjunctivitis, Superior Limbic: Differential Diagnoses & Workup

Author: James H Oakman Jr, MD, Partner, Southern Eye Center, Augusta, Georgia
Contributor Information and Disclosures

Updated: Nov 6, 2008

Differential Diagnoses

Conjunctivitis, Allergic
Keratoconjunctivitis, Epidemic
Conjunctivitis, Bacterial
Keratoconjunctivitis, Sicca
Conjunctivitis, Giant Papillary
Red Eye Evaluation
Conjunctivitis, Viral
Sebaceous Gland Carcinoma
Dry Eye Syndrome
Thyroid Ophthalmopathy
Episcleritis
Trachoma
Floppy Eyelid Syndrome

Other Problems to Be Considered

Filamentary keratopathy

Workup

Laboratory Studies

  • Thyroid evaluation - Thyroid-stimulating hormone, free thyroxine (T4), thyroid-stimulating immunoglobulin, or thyroid-stimulating hormone–binding inhibitory immunoglobulin
  • Schirmer test, measurement of tear lake, and tear breakup time evaluating for dry eye syndrome, which is often present with SLK

Histologic Findings

Surgical specimens taken from patients with SLK who had not received treatment with silver nitrate demonstrate abnormal limbic epithelium with keratinized epithelial cells with dyskeratosis and acanthosis and balloon degeneration of some nuclei. The intracellular accumulation of glycogen in the epithelial cells of tissue sections of the bulbar conjunctiva has been documented. The conjunctival stroma demonstrates edema without significant inflammatory cellular infiltrate. In specimens obtained after silver nitrate treatment, significant numbers of inflammatory cells, including plasma cells, neutrophils, and lymphocytes, also are found in the epithelium and stroma.

Immunohistochemical pathologic examination of the abnormal conjunctiva in SLK demonstrates a lack of the typical mosaic pattern of the epithelium in the resulting keratinized cells before undergoing treatment and up-regulation of transforming growth factor-beta 2 and tenascin. In separate studies, increased expression of proliferating cell nuclear antigens and altered expression of cytokines, as well as the presence of involucrin, were shown.

More on Keratoconjunctivitis, Superior Limbic

Overview: Keratoconjunctivitis, Superior Limbic
Differential Diagnoses & Workup: Keratoconjunctivitis, Superior Limbic
Treatment & Medication: Keratoconjunctivitis, Superior Limbic
Follow-up: Keratoconjunctivitis, Superior Limbic
References
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References

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Further Reading

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Keywords

superior limbic keratoconjunctivitis, SLK, superior limbic filamentary keratoconjunctivitis

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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, Georgia Medical Society, Georgia Society of General Surgeons, and Georgia Society of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Stephen D Plager, MD, FACS, Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital
Stephen D Plager, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman 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

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

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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