Superior limbic keratoconjunctivitis (SLK) is a chronic and recurrent inflammatory ocular surface disease. It primarily affects the superior limbus, bulbar conjunctiva and tarsal conjunctiva. The main clinical manifestations are eye irritation, foreign body sensation and photophobia. However, its precise pathogenesis has not yet been fully elucidated. This review systematically summarizes the epidemiological features, clinical manifestations and associated comorbidities of SLK. The key roles of mechanical micro injury, tear film instability and immune inflammatory response in the occurrence and development of diseases were discussed in detail. Simultaneously, the article outlines the diagnostic points of SLK and focuses on the latest developments in metabolomics and lipidomics research. Diagnostic and therapeutic strategies such as conservative treatment and surgical treatment key diagnostic considerations are outlined as well. By integrating existing evidence, this review aims to provide a theoretical basis for the clinical diagnosis and management of SLK. It also offers insights for future mechanistic studies and the development of targeted therapeutic approaches.