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Superior limbic keratoconjunctivitis


Other Names:
SLK; Theodores superior limbic keratoconjunctivitis; Theodores syndrome; SLK; Theodores superior limbic keratoconjunctivitis; Theodores syndrome; Theodore superior limbic keratoconjunctivitis; Theodore syndrome See More
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Superior limbic keratoconjunctivitis (SLK) is a chronic and recurrent eye disease which affects the superior bulbar conjunctiva (the clear layer that covers the eyeball, over the sclera) and tarsal conjunctiva (the clear layer that lines the eyelids), as well as the superior limbic aspect of the cornea (the area above the cornea).[1][2] It is commonly found in women 20-70 years of age. The signs and symptoms include burning, redness and irritation and tend to develop slowly over a period of 1 to 10 years.[3] Vision usually remains intact. While the underlying cause of SLK remains unknown, it is believed that the condition is secondary to superior bulbar conjunctiva laxity.  Factors inducing conjunctiva laxity include  thyroid eye disease (usually hyperthyroidism), tight upper eyelids, and prominent globes.[1][2][3] A mimicking disorder has been encountered in soft contact lens (SCL) wearers, typically with exposure to thimerosal-preserved solutions.[2] Treatment of SLK may involve the use of various medications, surgery, or a combination of both.[4]
Last updated: 1/3/2017
The symptoms of SLK develop slowly over 1 to 10 years and usually occur in both eyes (bilateral). Vision is rarely affected. The most common symptoms include burning, irritation and redness.[2][3] These symptoms may be more pronounced when looking up.[2] 
Last updated: 10/6/2016
The cause of SLK is unknown. One of the most common theories suggests that the development of SLK is related to laxity or a loosening of the superior bulbar conjunctiva (the clear layer that covers the eyeball, over the sclera), resulting in friction and inflammation (swelling) between the upper eyelid and the eyeball. However, like other theories previously proposed, such as infectious, immunogenic and allergic, this theory lacks sufficient and convincing evidence to explain all of the developments of the disease. SLK may be associated with thyroid abnormalities, particularly hyperthyroidism, but is also found in individuals with normal thyroid function.[2][3] In advanced cases, superior limbal stem cell deficiency syndrome may occur from the repeated microtrauma to the limbal stem cells.[5]

A different condition, known as Contact Lens-Induced Superior Limbic Keratoconjunctivitis (CLSLK) is an eye inflammatory condition with an almost identical presentation, but it is related to contact lens wear.[6]
Last updated: 1/3/2017
Many different methods have been used to try to manage SLK with varying levels of success. The most common treatment is large diameter contact lens wear.[3][7] Other options include:[2][4]
  • Silver nitrate (antiseptic) solution  
  • Mast cell stabilizers (used to prevent or control allergic reactions)
  • Vitamin A preparations 
  • Cyclosporine A
  • Autologous (self) serum–derived drops
  • Botulinum injection to the overlying muscle
Surgical options include cryotherapy (use of cold to destroy abnormal tissue), conjunctival resection of the superior limbal conjunctiva, and thermal cautery of superior limbal conjunctiva, which may be curative.[3][7][4]

More detailed information related to the treatment of SLK can be accessed through Medscape Reference.
Last updated: 1/3/2017
In general, the prognosis for SLK is excellent. While the symptoms may last for years, most cases go into remission or totally resolve over time.[2]
Last updated: 1/3/2017

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Superior limbic keratoconjunctivitis. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.
  • The U.S. National Institutes of Health, through the National Library of Medicine, developed ClinicalTrials.gov to provide patients, family members, and members of the public with current information on clinical research studies. There is a study titled Screening Study for the Evaluation and Diagnosis of Potential Research Participants which may be of interest to you.

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Superior limbic keratoconjunctivitis. Click on the link to view a sample search on this topic.

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  1. Kabat AG. Lacrimal occlusion therapy for the treatment of superior limbic keratoconjunctivitis. Optom Vis Sci. 1998; http://www.ncbi.nlm.nih.gov/pubmed/9798210. Accessed 10/6/2016.
  2. Oakman JH. Superior Limbic Keratoconjunctivitis. Medscape Reference. April 23, 2015; http://emedicine.medscape.com/article/1194578-overview. Accessed 10/6/2016.
  3. Papaliodis GN. Superior Limbic Keratoconjunctivitis. The Ocular Immunology and Uveitis Foundation. http://www.uveitis.org/docs/dm/superior_limbal_keratoconjunctivitis.pdf.
  4. Guillermo Mendoza, A., Rodríguez-García, A., Bernfeld, E, Feldman, B.. Superior limbic keratoconjunctivitis. American Academy of Ophthalmology. August 15, 2015; http://eyewiki.aao.org/Superior_limbic_keratoconjunctivitis.
  5. Chelala E, El Rami H, Dirani A, Fakhoury H & Fadlallah A. Extensive superior limbic keratoconjunctivitis in Graves’ disease: case report and mini-review of the literature. Clinical Ophthalmology (Auckland, NZ). 2015; 9:467-468. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362972/.
  6. Contact Lens-Induced Superior Limbic Keratoconjunctivitis (CLSLK). Association of Optometric Contact Lens Educators. May, 2016; http://www.aocle.org/livingL/clslk.html.
  7. Fraunfelder FW. Liquid nitrogen cryotherapy of superior limbic keratoconjunctivitis. Am J Ophthalmol. 2009; http://www.ncbi.nlm.nih.gov/pubmed/18835475. Accessed 10/6/2016.