Superior Limbic Keratoconjunctivitis (SLK) Clinical Presentation

Updated: Apr 06, 2023
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
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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.


Physical Examination


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 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.