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Superior Limbic Keratoconjunctivitis (SLK)

Last updated Jan. 4, 2019

Approved by: Maulik P. Purohit MD, MPH

Superior Limbic Keratoconjunctivitis (SLK), also known as Theodore’s SLK, is an uncommon eye disorder that is characterized by repeated episodes (over many years) of inflammation of the cornea and conjunctiva (outer most membrane of the eyelid, in contact with the eyeball).

What are the other Names for this Condition? (Also known as/Synonyms)

  • SLK of Theodore
  • Superior Limbic Keratitis
  • Theodore's Superior Limbic Keratoconjunctivitis

What is Superior Limbic Keratoconjunctivitis? (Definition/Background Information)

  • Superior Limbic Keratoconjunctivitis (SLK), also known as Theodore’s SLK, is an uncommon eye disorder that is characterized by repeated episodes (over many years) of inflammation of the cornea and conjunctiva (outer most membrane of the eyelid, in contact with the eyeball)
  • It is understood that thyroid dysfunction leading to some sort of mechanical injury in certain eye parts, may be a contributory factor. However, the specific cause associated with SLK is unidentified
  • In most cases the symptoms clear and the condition resolves spontaneously; though recurrence of the disorder for many years is common. The long-term prognosis is generally very good

Who gets Superior Limbic Keratoconjunctivitis? (Age and Sex Distribution)

  • Individuals in the broad age group of 4-81 years are vulnerable to Superior Limbic Keratoconjunctivitis; though, middle-aged adults and women (aged between 20-70 years old) are more at risk
  • No racial or ethnic preference is noted

What are the Risk Factors for Superior Limbic Keratoconjunctivitis? (Predisposing Factors)

Some of the potential risk factors for Superior Limbic Keratoconjunctivitis include:

  • Graves' ophthalmopathy (also known as thyroid eye disease); there is a 3% probability that individuals suffering from this condition may be affected by SLK
  • Thyroid malfunction; hypothyroidism
  • Scarring of the conjunctiva, due to any disorder/infection
  • Any condition that causes reduced tearing from the eye for a prolonged period; like a chronic inflammation
  • Oxygen deprived eyelids causing tight-fitting eyelids, or closure of the eyes for long durations
  • Surgical procedures, which has caused structural or functional changes to the conjunctiva
  • An advancing age

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Superior Limbic Keratoconjunctivitis? (Etiology)

  • The exact cause of Superior Limbic Keratoconjunctivitis is unknown. They are thought to occur spontaneously, or due to certain morphological (anatomical) anomalies caused by abnormal thyroid function
  • Constant or continuous mechanical problem/trauma associated with certain eye parts, chiefly the conjunctiva and cornea, may cause SLK
  • The trauma or mechanical irritation to the eye could be due to an infection/disorder, surgical procedure injuries, age factor, and thyroid function disruption over a protracted duration
  • It is also thought that the body’s autoimmune response could be a reason for SLK; considering the signs & symptoms, thyroid abnormalities, and the preference of the condition for females

What are the Signs and Symptoms of Superior Limbic Keratoconjunctivitis?

The intensity of signs and symptoms may vary from time to time; and both eyes may be affected. Common presentations of Superior Limbic Keratoconjunctivitis are:

  • Itching and redness of the eye(s)
  • Eye pain and eyelid inflammation/thickening; with gritty feeling of sand-like particles inside the eye
  • Continuous discharge of water from the eyes
  • Blurred vision, mild light sensitivity
  • The conjunctivitis infection-like symptoms occur repeatedly and regularly over many years; usually over a period of 10 years, till they finally stop

How is Superior Limbic Keratoconjunctivitis Diagnosed?

Diagnostic tests performed for Superior Limbic Keratoconjunctivitis are:

  • The ophthalmologist or physician performs an eye examination and evaluates the patient’s medical history. A prolonged occurrence of the condition is a significant indicator of SLK
  • Thyroid function investigation by an endocrinologist
  • Slit lamp exam (if necessary), for a detailed study of the eye
  • Specific tests to measure eye tearing
  • Examination of conjunctival scrapings
  • Differential diagnosis of other types of conjunctivitis should be considered, in order to eliminate other eye conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Superior Limbic Keratoconjunctivitis?

Complications may arise if Superior Limbic Keratoconjunctivitis is not treated. It is also dependent upon other disorders present (if any). The complications may include:

  • Prolonged discomfort and irritation; physical and emotional stress
  • Corneal scar which may result in loss of vision
  • Severe eye dryness
  • Complications that may occur from various treatment modes

How is Superior Limbic Keratoconjunctivitis Treated?

There is no specific treatment that cures an individual with Superior Limbic Keratoconjunctivitis. Symptomatic management of the condition is followed. Some methods include:

  • Application of warm compress can help reduce discomfort
  • Use of lubricating drops may soothe the eyes, and are helpful if eyes remain dry
  • Use of topical steroids, cyclosporine
  • Special contact lenses called, large-diameter ‘bandage soft contact lenses’ (BCL), has been proven to bring a measure of relief from the symptoms and improve the condition faster. Nevertheless, this is a temporary solution
  • Cryotherapy; where liquid nitrogen is used as a therapy tool. It is considered safe and effective
  • Surgical intervention techniques; such as thermocautery, conjunctival resection
  • Lacrimal punctal occlusion therapy; a technique to improve the dry-eye condition, by inserting silicone plugs into the eye drainage area
  • Treatment of the thyroid condition, if normal functioning of the thyroid gland is disrupted
  • Avoid the use of contact lenses (worn for optical correction) during this period; wear eye glasses instead

How can Superior Limbic Keratoconjunctivitis be Prevented?

  • Superior Limbic Keratoconjunctivitis is an eye disorder of unknown cause, and hence it cannot be prevented
  • However, certain steps can be taken to preserve the eye condition: Always maintain hygiene, wash hands regularly, and prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke. Also, avoid touching or rubbing the eyes
  • Stop or restrain yourself from smoking tobacco, or drinking alcohol
  • Be aware of the prolonged nature of the condition and always be prepared to deal with the disorder
  • Consider regular check-ups for thyroid hormone related problems; if you chronically suffer from such a thyroid condition

What is the Prognosis of Superior Limbic Keratoconjunctivitis? (Outcomes/Resolutions)

  • Most cases of Superior Limbic Keratoconjunctivitis have an excellent outcome; though the natural course of SLK presents many recurrent episodes over several years
  • Excessive dryness of the eyes, severe thyroid aberrations, and other such complications, may cause further discomfort. However, serious problems have not been reported

Additional and Relevant Useful Information for Superior Limbic Keratoconjunctivitis:

  • Almost 50% of the individuals with Superior Limbic Keratoconjunctivitis are said to suffer from another condition, called Dry Eye Syndrome (Keratoconjunctivitis sicca)
  • Another form of SLK is known as Contact Lens – SLK, which occurs due to prolonged usage of a certain type of contact lens. This condition is different from Theodore’s SLK

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 19, 2013
Last updated: Jan. 4, 2019