Case Report: A 75-year-old Japanese woman was referred to us for persistent irritation in September 2006. She reported a history of foreign body sensation in the left eye for 4 years. Slit lamp examination revealed hypertrophy, hyperemia, and pronounced fluorescein staining of the superior bulbar conjunctiva in the left eye (Figure 1-A, B). Schrimer's test results were 2 mm in the right eye and 1 mm in the left eye. The diagnosis of SLK with aqueous deficiency dry eye was made based on these findings. Initially, treatment was attempted with 0.1% fluorometholone and 0.1% sodium hyaluronate eyedrops without success. Punctal plugs inserted to the upper and the lower puncta provided little symptomatic relief.