Superior Limbic Keratoconjunctivitis (SLK) Clinical Presentation

Updated: Dec 09, 2019
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
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The natural history of superior limbic keratoconjunctivitis is usually a chronic course with gradual clearing. 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.


Physical Examination


Patients with superior limbic keratoconjunctivitis present with complaints of tearing, burning, foreign body sensation, mild photophobia, and mucous discharge. Some patients may also present with redness.

Superior limbic keratoconjunctivitis is most often bilateral, although one eye may be more symptomatic.

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.

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.


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.