Superior limbic keratoconjunctivitis easily can be mistaken for dry eye disease, because patients frequently complain of grittiness, dryness, irritation and decreased contact lens wear time. It’s important to note that filamentary keratitis often is associated with dry eye disease; however, when the filaments are limited to the superior corneal location, consider SLK as the more likely diagnosis. Tear film osmolarity is a key differentiator in these instances—patient scores will be elevated in cases of filamentary keratitis secondary to dry eye disease, but not in cases of SLK.
SLK is most effectively identified via the instillation of sodium fluorescein dye. If staining only appears on the cornea, and not the conjunctiva, consider a diagnosis of limbal stem cell deficiency—especially if the presentation is associated with neovascularization or even conjunctivilization and epitheliopathy. If, however, staining involves the superior cornea, limbus and conjunctiva, consider SLK. Upper tarsal conjunctival hyperemia also is a common finding in cases of SLK.
Because so many conditions can mimic dry eye disease, it is important to establish sound guidelines for completing a differential—particularly when the aforementioned clinical findings point to a very different diagnosis.
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