Symptoms remit and exacerbate and are variable in degree, but no diurnal pattern to the worsening of symptoms exists. In most cases, the condition is present bilaterally, although one eye may be more symptomatic. Patients with filaments are usually extremely symptomatic. Commonly, a history of thyroid dysfunction is elicited upon questioning. The natural history of SLK is prolonged, with gradual clearing.
Patients often have numerous eye specialists for their symptoms.
Unless the doctors have specifically examined the upper bulbar conjunctivae or everted the upper eyelids, they may have missed the diagnosis. The conjunctiva extending from the upper limbus to the insertion of the superior rectus muscle also demonstrates thickening, hyperemia, and typical rose bengal staining. It stands out in stark contrast to the normal appearance of the inferior conjunctiva and cornea. Approximately one third of patients present with filaments on the upper cornea or along the superior limbus. SLK is associated with thyroid dysfunction.