History

The natural history of superior limbic keratoconjunctivitis usually is 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 previously may have been missed.

Symptoms

Patients with superior limbic keratoconjunctivitis present with complaints of tearing, burning, foreign body sensation, mild photophobia, and mucous discharge. Some patients may present with redness. There usually is no chronic visual impairment, but there may be occasional periods of transient blurred vision.

Superior limbic keratoconjunctivitis most often is bilateral, although 1 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, the usage of moisturizing medications provides only minimal symptomatic relief.

Corneal filaments increase foreign body sensation and blepharospasm, so patients with corneal filaments usually are extremely symptomatic. This also can distract the examiner's attention from the underlying condition.

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

Signs

Signs of superior limbic keratoconjunctivitis are marked inflammation with hyperemic papillary reaction in the upper lid tarsal conjunctiva, inflammation of the upper bulbar conjunctiva, thickening of the upper limbal epithelium and surrounding conjunctiva, punctate staining on the upper limbus, adjacent conjunctiva, and/or cornea.

The conjunctiva extending from the upper limbus to the insertion of the superior rectus muscle also demonstrates thickening, hyperemia, and typical staining with fluorescein, rose bengal, and lissamine green. Other clinical findings include erosion or micropannus in the upper cornea, diffuse corneal epithelial erosion, conjunctival hyperemia, pseudomembranes in the upper lid tarsal conjunctiva, and eyelid edema.

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

Differential Diagnoses

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Author

Jean Deschênes, MD, FRCSC Professor, Research Associate, Director, Uveitis Program, Department of Ophthalmology, McGill University Faculty of Medicine; Senior Ophthalmologist, Clinical Director, Department of Ophthalmology, Royal Victoria Hospital, Canada

Jean Deschênes, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, International Ocular Inflammation Society, Quebec Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jia Yue You, MDCM Resident Physician, Department of Ophthalmology, McGill University Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Kubra Ozdemir Yalcinsoy, MD Cornea, External Disease and Uveitis Observer, Department of Ophthalmology, McGill University Health Center, McGill University Faculty of Medicine, Canada

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, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, 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, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab<br/>stock options for: RPS, Fount Bio.

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.

Additional Contributors

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.

Susan Ruyu Qi University of Montreal Faculty of Medicine, Canada

Disclosure: Nothing to disclose.