Conjunctivitis physical examination: Difference between revisions

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{{Conjunctivitis}}
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{{CMG}}; {{AE}} {{SaraM}}


==Overview==
==Overview==
Physical examination of patients with conjunctivitis is usually remarkable for [[conjunctival]] [[injections]], [[epiphora]], [[hyperemia]], [[chemosis]] and muco-purulent or watery discharge. However, [[ophthalmologic]] examination may be varies based on conjunctivitis subtypes.
Physical examination of patients with conjunctivitis is usually remarkable for [[conjunctival]] [[injections]], [[epiphora]], [[hyperemia]], [[chemosis]], and muco-purulent or watery discharge. However, [[ophthalmologic]] examination may be varies based on conjunctivitis subtypes.<ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref><ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>


==Physical Examination==
==Physical Examination==
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*[[Hyperemia]]
*[[Hyperemia]]
*[[Chemosis]]
*[[Chemosis]]
*[[Lymphoid]] [[follicle]] on the undersurface of the eyelid
*Lymphoid follicle on the under-surface of the eyelid
*Follicular conjunctival reaction
*Follicular conjunctival reaction
*Pseudomembranous (occasionally)
*Pseudomembrane formation (occasionally)
*[[Cicatricial]] [[conjunctival]] reaction
*[[Cicatricial]] conjunctival reaction
*[[Eyelids]] [[ecchymosis]]  
*Eyelids [[ecchymosis]]
*[[Corneal]] [[epithelial]] defect (severe cases)
*Corneal epithelial defect (in severe cases)
 
===Acute Hemorrhagic Conjunctivitis===
===Acute Hemorrhagic Conjunctivitis===
[[Ophthalmologic]] examination of patients with acute hemorrhagic conjunctivitis is usually remarkable for:<ref name="pmid1088513">{{cite journal| author=Yin-Murphy M| title=Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis). | journal=Bull World Health Organ | year= 1976 | volume= 54 | issue= 6 | pages= 675-9 | pmid=1088513 | doi= | pmc=2366581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1088513  }} </ref>
[[Ophthalmologic]] examination of patients with acute hemorrhagic conjunctivitis is usually remarkable for:<ref name="pmid1088513">{{cite journal| author=Yin-Murphy M| title=Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis). | journal=Bull World Health Organ | year= 1976 | volume= 54 | issue= 6 | pages= 675-9 | pmid=1088513 | doi= | pmc=2366581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1088513  }} </ref>
*Eyelid [[edema]]  
*Eyelid [[edema]]
*Eye pain in [[palpation]]
*[[Eye pain]] in palpation
*[[Bulbar]] [[conjunctiva]] [[hemorrhage]]
*Bulbar conjunctival [[hemorrhage]]
 
===Bacterial Conjunctivitis===
===Bacterial Conjunctivitis===
Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref><ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref><ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
*[[Bulbar]] [[conjunctival]] [[injection]]
*Bulbar conjunctival injection
*Palpebral [[conjunctival]] [[papillary]] reaction
*Palpebral conjunctival papillary reaction
*Muco-purulent or watery discharge
*Watery or [[mucopurulent discharge]]
*[[Chemosis]]
*[[Chemosis]]
*Lid [[erythema]]
*Lid [[erythema]]
*[[Corneal]] involvement (''[[Neisseria gonorrhea]]'')
*Corneal involvement (''[[Neisseria gonorrhea]]'')
 
===Neonatal Conjunctivitis===
===Neonatal Conjunctivitis===
Ophthalmologic examination of patients with neonatal conjunctivitis or [[ophthalmia neonatorum]] is usually remarkable for:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
Ophthalmologic examination of patients with neonatal conjunctivitis or [[ophthalmia neonatorum]] is usually remarkable for:<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name=ophthalmia-two>Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.</ref><ref name=Ophthalmia-three>Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.</ref>
*''[[Neisseria gonorrhea]]''
*''[[Neisseria gonorrhea]]''
**Chemosis
**[[Chemosis]]
**Severe lid [[edema]]
**Severe lid edema  
**[[Mucopurulent]] discharge
**[[Mucopurulent discharge]]
**[[Corneal]] involvement (diffuse [[epithelial edema]], [[ulceration]], corneal [[perforation]], and [[endophthalmitis]]
**[[Corneal]] involvement (diffuse epithelial edema, [[ulceration]], corneal perforation, and [[endophthalmitis]]
*''[[Chlamydia trachomatis]]''
*''[[Chlamydia trachomatis]]''
**Mild [[hyperemia]]  
**Mild [[hyperemia]]  
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**Pseudomembrane formation
**Pseudomembrane formation
*[[Chemical]]
*[[Chemical]]
**Mild [[conjunctival]] [[injection]]
**Mild conjunctival injection  
**[[Epiphora]]
**[[Epiphora]]
===Allergic Conjunctivitis===
===Allergic Conjunctivitis===
Ophthalmologic examination of patients with [[allergic conjunctivitis]] is usually remarkable for:<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue=  | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516  }} </ref>
Ophthalmologic examination of patients with [[allergic conjunctivitis]] is usually remarkable for:<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref><ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue=  | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516  }} </ref>
*[[Bilateral]] conjunctival [[injection]]
*[[Bilateral]] conjunctival injection
*[[Chemosis]]
*[[Chemosis]]
*Watery [[discharge]] or mild mucous discharge
*Watery discharge or mild mucous discharge
*Large [[cobblestone]] [[papillae]] under upper [[eyelid]]
*Large cobblestone papillae under upper eyelid
 
===Keratoconjunctivitis Sicaa===
===Keratoconjunctivitis Sicaa===
Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, [[eyelashes]], [[conjunctiva]], [[cornea]], and tear film.
Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, [[eyelashes]], [[conjunctiva]], [[cornea]], and tear film.
Examination of patients with [[keratoconjunctivitis sicaa]] is usually remarkable for:<ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935  }} </ref><ref name="pmid19506195">{{cite journal| author=Schaumberg DA, Dana R, Buring JE, Sullivan DA| title=Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies. | journal=Arch Ophthalmol | year= 2009 | volume= 127 | issue= 6 | pages= 763-8 | pmid=19506195 | doi=10.1001/archophthalmol.2009.103 | pmc=2836718 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19506195  }} </ref>
Examination of patients with [[keratoconjunctivitis sicaa]] is usually remarkable for:<ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935  }} </ref><ref name="pmid19506195">{{cite journal| author=Schaumberg DA, Dana R, Buring JE, Sullivan DA| title=Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies. | journal=Arch Ophthalmol | year= 2009 | volume= 127 | issue= 6 | pages= 763-8 | pmid=19506195 | doi=10.1001/archophthalmol.2009.103 | pmc=2836718 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19506195  }} </ref>
*More or less pronounced [[conjunctival]] [[redness]]
*Conjunctival redness
*Damage to the ocular surface with punctate [[epithelial]] [erosions (superficial punctate [[keratitis]]) 
*Damage to the ocular surface with punctate epithelial  
*Thickened eyelid margins and [[telangiectasia]] (signs of [[meibomian gland]] [[dysfunction]])
*Thickened eyelid margins and [[telangiectasia]] (signs of [[meibomian gland]] [[dysfunction]])
*[[Meibomian gland]] orifices are obstructed with a cloudy, granular or solid [[secretion]] (expressed by exerting considerable pressure on the lower lid)
*[[Meibomian gland]] orifices are obstructed with a cloudy or granular [[secretion]] (expressed by exerting considerable pressure on the lower lid)
*[[Blepharitis]] (associated with meibomian gland dysfunction)
*[[Blepharitis]] (associated with meibomian gland dysfunction)
*Meibomitis ([[inflammation]] of the meibomian glands)  
*Meibomitis ([[inflammation]] of the meibomian glands)  
Line 65: Line 70:
Ophthalmologic examination of patients with [[superior limbic keratoconjunctivitis|superior limbic keratoconjunctivitis (SLK)]] is usually remarkable for:<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref>
Ophthalmologic examination of patients with [[superior limbic keratoconjunctivitis|superior limbic keratoconjunctivitis (SLK)]] is usually remarkable for:<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref>
*[[Hyperemia]]  
*[[Hyperemia]]  
*Micro-papillary reaction in the upper tarsal conjunctiva,
*Micro-papillary reaction in the upper tarsal conjunctiva
*Thickening of the [[superior]] [[bulbar]] [[conjunctiva]]
*Thickening of the superior bulbar conjunctiva
*Ciliary [[injection]] in the upper bulbar conjunctiva
*Ciliary injection in the upper bulbar conjunctiva
*[[Corneal]] erosions in the upper quadrants
*Corneal erosion in the upper quadrants
*[[Diffuse]] [[superficial]] corneal erosions
*Diffuse superficial corneal erosions
*Eyelid [[edema]]
*Eyelid edema


===Images===
The following are gross images associated with conjunctivitis.<ref name=Grosss-Images> courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA) </ref>
<div align="left">
<gallery heights="175" widths="175">
Image:eyes_conjunctivitis.jpg|Conjunctivitis: Note inflamed conjunctiva of sclera and reflection onto underside of eyelid.
Image:eyes_conjunctivitis2.jpg|Conjunctivitis: Marked bilateral inflammation involving conjunctiva that covers sclera and under surface of eyelid. Thick exudate can also be seen.
Image:eyes_conjunctivitis3.jpg|Conjunctivitis: Inflammation of conjunctiva covering sclera and under surface of eyelid.
</gallery>
</div>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Immunology]]
[[Category:Immunology]]
[[Category:Pediatrics]]
[[Category:FinalQCRequired]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Primary care]]
[[Category:Pediatrics]]

Latest revision as of 21:07, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Physical examination of patients with conjunctivitis is usually remarkable for conjunctival injections, epiphora, hyperemia, chemosis, and muco-purulent or watery discharge. However, ophthalmologic examination may be varies based on conjunctivitis subtypes.[1][2]

Physical Examination

Viral Conjunctivitis

Patients with viral conjunctivitis usually appear febrile, and they have preauricular adenopathy. Ophthalmologic examination of patients with viral conjunctivitis is usually remarkable for:[1][2]

  • Epiphora
  • Hyperemia
  • Chemosis
  • Lymphoid follicle on the under-surface of the eyelid
  • Follicular conjunctival reaction
  • Pseudomembrane formation (occasionally)
  • Cicatricial conjunctival reaction
  • Eyelids ecchymosis
  • Corneal epithelial defect (in severe cases)

Acute Hemorrhagic Conjunctivitis

Ophthalmologic examination of patients with acute hemorrhagic conjunctivitis is usually remarkable for:[3]

Bacterial Conjunctivitis

Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:[4][5]

Neonatal Conjunctivitis

Ophthalmologic examination of patients with neonatal conjunctivitis or ophthalmia neonatorum is usually remarkable for:[6][7][8]

Allergic Conjunctivitis

Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:[4][9]

  • Bilateral conjunctival injection
  • Chemosis
  • Watery discharge or mild mucous discharge
  • Large cobblestone papillae under upper eyelid

Keratoconjunctivitis Sicaa

Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, eyelashes, conjunctiva, cornea, and tear film. Examination of patients with keratoconjunctivitis sicaa is usually remarkable for:[10][11]

Superior Limbic Keratoconjunctivitis

Ophthalmologic examination of patients with superior limbic keratoconjunctivitis (SLK) is usually remarkable for:[12]

  • Hyperemia
  • Micro-papillary reaction in the upper tarsal conjunctiva
  • Thickening of the superior bulbar conjunctiva
  • Ciliary injection in the upper bulbar conjunctiva
  • Corneal erosion in the upper quadrants
  • Diffuse superficial corneal erosions
  • Eyelid edema

References

  1. ↑ 1.0 1.1 Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
  2. ↑ 2.0 2.1 Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  3. ↑ Yin-Murphy M (1976). "Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)". Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.
  4. ↑ 4.0 4.1 Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  5. ↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
  6. ↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
  7. ↑ Rours, Ingrid GIJG, et al. "Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants." Pediatrics 121.2 (2008): e321-e326.
  8. ↑ Pickering, Larry K. Red book®: 2003 report of the committee on infectious diseases. No. Ed. 26. American Academy of Pediatrics, 2003.
  9. ↑ La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). "Allergic conjunctivitis: a comprehensive review of the literature". Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.
  10. ↑ Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands". Cornea. 17 (6): 584–9. PMID 9820935.
  11. ↑ Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). "Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies". Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.
  12. ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
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