Superior Limbic Keratoconjunctivitis (SLK)

Superior Limbic Keratoconjunctivitis (SLK)
SYMPTOMS Pain | Burning | Photophobia
SIGNS Superior bulbar conjunctival injection and thickening | Tearing | Superior corneal/limbal/conjunctival staining with NaFl
WORK-UP Thorough history and slit lamp exam with NaFl. Lift the upper eyelid and ask the patient to look down.
TOPICAL: Preservative-free artificial tears | steroids (Pred Forte 1% or Lotemax 1 gtt qid). Steroids should be tapered slowly to avoid rebound inflammation | Consider long-term cyclosporine 0.05%
Botox injections into the muscle of Riolan may help reduce friction
In severe cases, surgery may be considered: Conjunctival resection | Cautery | Cryotherapy
FOLLOW-UP Every 2-4 weeks during treatment. Every 6 months for monitoring
ADDITIONAL LAB | TESTS Thyroid function testing
ETIOLOGY Unknown | SLK has been associated with thyroid dysfunction.
DIFFERENTIAL DX Episcleritis | Scleritis | Keratoconjunctivitis sicca | Sjogren’s syndrome | Viral conjunctivitis | Floppy eyelid syndrome
NOTES SLK can wax and wane and remain a chronic condition