Conjunctivitis

Main causes of chronic follicular conjunctivitis

• Molluscum
• Drug toxicity
• Chlamydial infections: trachoma or inclusion conjunctivitis

• Inclusion conjunctivitis: sexually-transmitted, with large lower palpebral follicles, subepithelial infiltrates (like adenoviral conjunctivitis). Requires systemic antibiotics (oral azithromycin 1 gram single dose, or doxycycline course)

Vernal conjunctivitis (contrast with atopic keratoconjunctivitis)

• Seasonal allergic conjunctivitis

• Typically presents within the first two decades

• Differential: blepharokeratoconjunctivitis (which has more mild upper tarsal findings)

• Caucasians typically develop the tarsal/palpebral form, whereas darker skinned people develop the limbal form

• M>F
• Features
• Itching
• Thick mucous discharge

• Giant ‘cobblestone’ papillae (vs. flat scarred tarsal conjunctiva in chronic AKC)

• Horner-Trantas dots: jellylike limbal nodules representing degenerating eosinophil aggregates

• Shield ulcer
• Superior PEEs
• Management:
• Mast cell stabiliser eg sodium cromoglicate
• Topical steroids
• Topical ciclosporin
• Mucolytics: acetylcysteine 
• Immunosuppression in severe cases including oral steroids

Adenoviral conjunctivitis

• Two forms:

• Pharyngoconjunctival fever: typically affects young children with systemic upset and rarely with subepithelial infiltrates

• Epidemic keratoconjunctivitis: typically affects adults, rarely with systemic upset and more commonly with subepithelial infiltrates

• Both show follicular conjunctivitis and tender preauricular lymphadenopathy