Superior Limbic Keratoconjunctivitis: Pathophysiology, Diagnosis, and Advances in Therapeutic Strategies.

Abstract

Background: Superior limbic keratoconjunctivitis (SLK) is a chronic inflammatory disorder of the ocular surface, primarily affecting the superior bulbar and palpebral conjunctiva. It predominantly occurs in middle-aged women and is associated with conditions, such as dry eye disease, thyroid eye disease, and ocular graft-versus-host disease. Although its exact etiology remains unclear, mechanical microtrauma and tear film instability are key contributing factors. Given its relapsing-remitting nature, early diagnosis and appropriate management are essential to prevent chronic ocular discomfort and visual disturbances.

Purpose: To provide a comprehensive review of the pathophysiology, clinical presentation, diagnosis, and management strategies for SLK, emphasizing the latest advances in medical and surgical treatment.

Methods: A literature review was conducted to analyze current evidence on the mechanisms, diagnosis, and treatment of SLK. The therapeutic approaches were categorized into medical, mechanical, and surgical interventions, highlighting their indications, efficacy, and limitations. Emerging treatments and their potential role in SLK management were also evaluated.

Conclusion: SLK is an often underdiagnosed yet significant ocular surface disorder that requires a customized treatment approach. The management of SLK focuses on minimizing mechanical friction and controlling inflammation. In mild cases, patients typically respond well to ocular lubricants and mast cell stabilizers. For moderate cases, treatment may involve punctal occlusion and immunomodulatory therapy. Severe or refractory cases can benefit from supratarsal corticosteroid injections, scleral lenses, or surgical interventions such as conjunctival resection or thermal cauterization. While the overall prognosis is generally favorable, recurrence is common. Therefore, long-term follow-up is essential to optimize treatment outcomes and reduce the likelihood of relapses.