All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Upper limbal keratoconjunctivitis
Medical expert of the article
Last reviewed: 07.07.2025
Superior limbal keratoconjunctivitis Theodore is a rare chronic inflammation that usually affects middle-aged women, possibly suffering from thyroid dysfunction. Superior limbal keratoconjunctivitis is often misdiagnosed, as subjective symptoms are more pronounced than objective ones. The condition is usually bilateral, although the manifestation may be asymmetric. The course is long, with periods of remission and exacerbation before eventual recovery.
Symptoms of superior limbal keratoconjunctivitis
Superior limbal keratoconjunctivitis presents with nonspecific signs: foreign body sensation, burning, photophobia, and mucous discharge. Papillary hypertrophy of the upper tarsal conjunctiva, which may appear as a diffusely velvety surface. Hyperemia of the superior bulbar conjunctiva, which is most intense near the limbus and diminishes toward the superior fornix. Conjunctival epithelial cells may become keratinized, and the affected area loses luster. Punctate epithelial erosions in the superior portion are common.
Upper filamentous keratitis occurs in approximately 1/3 of patients and is not necessarily associated with insufficient tear production. Dry keratoconjunctivitis occurs in approximately 25% of cases.
What do need to examine?
How to examine?
Treatment of superior limbal keratoconjunctivitis
Aimed primarily at preventing mechanical interaction between the upper eyelid and the upper limbus. There is no specific treatment.
- Tear substitutes for dry eyes.
- Acetylcysteine 5% for filamentous keratitis.
- Occlusion of the superior lacrimal punctum is usually effective.
- Soft contact lenses placed between the eyelid and the limbus are also effective.
- Cauterization of the superior boulevard conjunctiva is safe and often effective.