Cornea
Superior Limbic Keratoconjunctivitis
Also known as: SLK, superior limbic keratoconjunctivitis, Theodore's SLK, superior corneal injection, superior conjunctival inflammation, thyroid SLK, superior SPK, filamentary superior keratitis
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A chronic inflammatory condition of the superior bulbar conjunctiva and superior cornea, associated with thyroid dysfunction (Graves' disease) in approximately 50% of cases. Also associated with contact lens wear and dry eye. Theodore's SLK presents with superior bulbar conjunctival injection, fine SPK limited to the superior limbus, filamentary keratitis, and thickened superior conjunctiva. Characteristically resolves and recurs.
Recognition
Symptoms: what patients report
- Bilateral or unilateral foreign-body sensation.
- Redness — predominantly at the superior limbus.
- Burning and mild discomfort.
- Watering.
- Photophobia — usually mild.
- Symptoms worse on upgaze or lid squeezing.
- History of thyroid disease in ~50% of cases.
- Contact lens wear history.
Signs: what the examination shows
- Superior bulbar conjunctival injection — hyperaemia limited to the superior limbal zone (under the upper lid).
- Thickened, redundant superior bulbar conjunctiva — papillary or velvety appearance.
- Superior limbal corneal SPK — fine punctate epithelial erosions at the superior limbus.
- Filamentary keratitis — mucous filaments at the superior limbus.
- Rose bengal staining of the superior conjunctiva and superior cornea.
- Conjunctival keratinisation in chronic cases.
- Micropannus (superficial vascularisation) at the superior limbus in advanced cases.
What OptoGuide™ covers for superior limbic keratoconjunctivitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Superior Limbic Keratoconjunctivitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Recharacterization of superior limbic keratoconjunctivitis via a subdividing grading method in 236 Chinese patients. Cheng C, Zhu M, Lin T, et al. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht V
- Insights Into the Pathophysiology of Superior Limbic Keratoconjunctivitis in Chronic Ocular Graft-Versus-Host Disease. Bibak-Bejandi Z, Azar M, Shahjahan S, Abedi F, Djalilian AR. Eye & Contact Lens. 2025;51(7):290-295.
- Risk factors for development of superior limbic keratoconjunctivitis in thyroid eye disease in Japanese. Takahashi Y, Vaidya A, Kakizaki H. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Grae
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.