Superior Limbic Keratoconjunctivitis Differential Diagnoses
- Author: James H Oakman Jr, MD; Chief Editor: Hampton Roy Sr, MD more...
Diagnostic Considerations
The clinical presentation of superior limbic keratoconjunctivitis (SLK) is generally distinct enough from other eye conditions to make the diagnosis. Its prolonged clinical course with remission and exacerbations as well as the more common presence of punctate keratitis and filaments than occurs in the mimicking soft contact lens syndrome (which has been associated with thimerosal-preserved solutions) help to distinguish these 2 conditions. Filamentary keratopathy and conjunctivitis conditions (allergic, bacterial, giant papillary, viral conjunctivitis) are other considerations.
See the following for more information:
Differential Diagnoses
- Dry Eye Syndrome
- Episcleritis
- Floppy Eyelid Syndrome
- Keratoconjunctivitis, Epidemic
- Keratoconjunctivitis, Sicca
- Red Eye Evaluation
- Sebaceous Gland Carcinoma
- Thyroid Ophthalmopathy
- Trachoma
Thygeson P, Kimura SJ. Chronic conjunctivitis. Trans Am Acad Ophthalmol Otolaryngol. Jul-Aug 1963;67:494-517. [Medline].
Tenzel RR. Comments on superior limbic filamentous keratitis: II. Arch Ophthalmol. Apr 1968;79(4):508. [Medline].
Corwin ME. Superior limbic keratoconjunctivitis. Am J Ophthalmol. Aug 1968;66(2):338-40. [Medline].
Smolin G, Thoft RA. Superior limbic keratoconjunctivitis. In: Ostler HB, ed. The Cornea. 2nd ed. 1987;1:296-9.
Stenson S. Superior limbic keratoconjunctivitis associated with soft contact lens wear. Arch Ophthalmol. Mar 1983;101(3):402-4. [Medline].
Cher I. Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis. Clin Experiment Ophthalmol. Jun 2000;28(3):181-4. [Medline].
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. May 2007;26(4):490-2. [Medline].
Cher I. Blink-related microtrauma: when the ocular surface harms itself. Clin Experiment Ophthalmol. Jun 2003;31(3):183-90. [Medline].
Matsuda A, Tagawa Y, Matsuda H. TGF-beta2, tenascin, and integrin beta1 expression in superior limbic keratoconjunctivitis. Jpn J Ophthalmol. Jul-Aug 1999;43(4):251-6. [Medline].
Matsuda A, Tagawa Y, Matsuda H. Cytokeratin and proliferative cell nuclear antigen expression in superior limbic keratoconjunctivitis. Curr Eye Res. Oct 1996;15(10):1033-8. [Medline].
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. Nov 2000;21(5):877-85. [Medline].
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. May 2011;52(6):3701-5. [Medline].
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. Aug 2010;51(8):3986-92. [Medline].
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. Mar 2008;145(3):445-452. [Medline].
Udell IJ, Kenyon KR, Sawa M, et al. Treatment of superior limbic keratoconjunctivitis by thermocauterization of the superior bulbar conjunctiva. Ophthalmology. Feb 1986;93(2):162-6. [Medline].
Fraunfelder FW. Liquid nitrogen cryotherapy of superior limbic keratoconjunctivitis. Am J Ophthalmol. Feb 2009;147(2):234-238.e1. [Medline].
Kojima T, Higuchi A, Goto E, Matsumoto Y, Dogru M, Tsubota K. Autologous serum eye drops for the treatment of dry eye diseases. Cornea. Sep 2008;27 Suppl 1:S25-30. [Medline].
Chun YS, Kim JC. Treatment of superior limbic keratoconjunctivitis with a large-diameter contact lens and Botulium Toxin A. Cornea. Aug 2009;28(7):752-8. [Medline].
Shen YC, Wang CY, Tsai HY, et al. Supratarsal triamcinolone injection in the treatment of superior limbic keratoconjunctivitis. Cornea. May 2007;26(4):423-6. [Medline].
Passons GA, Wood TO. Conjunctival resection for superior limbic keratoconjunctivitis. Ophthalmology. Aug 1984;91(8):966-8. [Medline].
Kheirkhah A, Casas V, Esquenazi S, et al. New surgical approach for superior conjunctivochalasis. Cornea. Jul 2007;26(6):685-91. [Medline].
Donshik PC, Collin HB, Foster CS, et al. Conjunctival resection treatment and ultrastructural histopathology of superior limbic keratoconjunctivitis. Am J Ophthalmol. Jan 1978;85(1):101-10. [Medline].
Goto E, Shimmura S, Shimazaki J, et al. Treatment of superior limbic keratoconjunctivitis by application of autologous serum. Cornea. Nov 2001;20(8):807-10. [Medline].
Yang HY, Fujishima H, Toda I, et al. Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis. Am J Ophthalmol. Jul 1997;124(1):80-7. [Medline].
Mondino BJ, Zaidman GW, Salamon SW. Use of pressure patching and soft contact lenses in superior limbic keratoconjunctivitis. Arch Ophthalmol. Dec 1982;100(12):1932-4. [Medline].
Watson S, Tullo AB, Carley F. Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. Br J Ophthalmol. Apr 2002;86(4):485-6. [Medline].
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. Sep 2010;29(9):1025-30. [Medline].
Sahin A, Bozkurt B, Irkec M. Topical cyclosporine a in the treatment of superior limbic keratoconjunctivitis: a long-term follow-up. Cornea. Feb 2008;27(2):193-5. [Medline].
Confino J, Brown SI. Treatment of superior limbic keratoconjunctivitis with topical cromolyn sodium. Ann Ophthalmol. Apr 1987;19(4):129-31. [Medline].
Grutzmacher RD, Foster RS, Feiler LS. Lodoxamide tromethamine treatment for superior limbic keratoconjunctivitis. Am J Ophthalmol. Sep 1995;120(3):400-2. [Medline].
Ohashi Y, Watanabe H, Kinoshita S, et al. Vitamin A eyedrops for superior limbic keratoconjunctivitis. Am J Ophthalmol. May 15 1988;105(5):523-7. [Medline].
Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al. Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis. Ophthalmology. Aug 2003;110(8):1578-81. [Medline].

