PATIENT: A 36-year-old Caucasian female presented to the office for eye discomfort.

HISTORY: A foreign body sensation which began in the left eye then moved to both eyes. Medical and ocular histories are otherwise unremarkable.

TESTING: Best-corrected acuity through a mild myopic prescription was 20/20 OD, OS, OU. Pupils, motility, and confrontation fields were all within normal limits. Intraocular pressures with Goldmann tonometry were 16 mmHg OD and 14mmHg OS.

EXAMINATION: Corneal exam revealed SPK and moderate bulbar injection superiorly.
All other findings were unremarkable.

Dx and Mx: With the findings given above, this patient was diagnosed with Superior Limbic Keratoconjunctivitis (SLK). SLK is usually bilateral and most often occurs in middle-aged females. 50% of these patients will have thyroid disease. Symptoms are often worse than the clinical signs. Her symptoms began in the left eye for which we placed a bandage lens and treated with Pred Forte q2h. A few weeks later she returned with similar but reduced findings in the right eye, which was also treated with Pred Forte this time QID. SLK has a tendency to have exacerbations and remissions which in the past has necessitated chronic steroid use. We are going to try and treat this patient with Restasis long term once the steroid has calmed the eye down.

PEARL: If suspicious of SLK rose bengal can aid in the diagnosis by showing superior bulbar staining.