Follicular conjunctivitis

Viral infection, especially epidemic keratoconjunctivitis (EKC), more often is associated with a follicular conjunctivitis, a serous conjunctival discharge, and preuricular lymphadenopathy. The exceptionally contagious organism causing EKC is not susceptible to antiviral therapy at this time. 

Diagnosis. In the classic form, vesicles form along the eyelid margin and/or periocular skin (Figure 23-16). The lesions are clear, pinhead in size, and have an inflamed erythematous base.Typically, within 1 week of presentation the vesicles break and ulcerate, resulting in a painful edematous blepharitis or dermatitis.The involved portion of the lid usually demonstrates mild swelling and tenderness. Pronounced conjunctival injection, a secondary follicular conjunctivitis, a weepy wet eye, and a regional lymphadenopathy may all be present. 

Adenoviral infection is a common cause of acute follicular conjunctivitis. More than 45 immunologically distinct... 

Adenoviral conjunctivitis classically presents as an acute follicular conjunctivitis.The infection usually is unilateral at onset but often becomes bilateral after several days. The second eye frequently is less severely involved than the first. Symptoms of adenoviral conjunctivitis include moderate foreign body sensation, tearing, and a watery to mucoid discharge. Patients often experience eyelid crusting, particularly on awakening. 

Inclusion conjunctivitis presents in teenagers and sexually active adults as an acute or chronic follicular conjunctivitis often accompanied by a mucopurulent discharge. Upper respiratory symptoms and fever generally are lacking. The disease often occurs in patients who have acquired a new sexual partner in the last 1 to 2 months. After an incubation period of 5 to 12 days, there is acute onset of conjunctival injection, mixed follicular-papillary... 

In its early stages trachoma presents as a chronic follicular conjunctivitis with a predilection for the superior tarsal and bulbar conjunctiva. Over time, the conjunctival reaction becomes papillary in nature and, with the inflammatory infiltration that occurs, the follicular character of the infection can become obscured. Patients experience symptoms of photophobia, tearing, and mucoid or mucopurulent discharge. Limbal edema and superior bulbar conjunctival hyperemia also may occur. Conjunctival follicles that form at the limbus are characteristic of severe trachoma. Primary corneal involvement often includes superior epithelial keratitis and superficial superior pannus formation. A wide variety of corneal infiltrates... 

Molluscum contagiosum is a dermatologic lesion caused by a poxvirus and is responsible for causing chronic or recurrent follicular conjunctivitis in patients who have lesions of the periorbital skin or eyelids. 

Acute conjunctivitis is a common feature of many other viral illnesses.The clinical manifestations are nonspecific, and knowledge of the systemic manifestations of these diseases leads to the appropriate diagnosis. Most cases result in mild, acute, transient, bilateral, follicular conjunctivitis. Treatment of the conjunctivitis in each case is generally supportive, with cold compresses, decongestants, and lubricants used to ease the symptoms of acute conjunctivitis. Table 25-5 summarizes clinical features of the most common viral illnesses with which conjunctivitis is associated. 

Several other infectious agents can cause follicular conjunctivitis and should be included in the differential diagnosis of either acute or chronic follicular conjunctivitis. 

Mombaerts IM, Maudgal PC, Knockaert DC. Bilateral follicular conjunctivitis as a manifestation of Lyme disease. Am J Ophthalmol 1991 98 96-97. 

Although pain, photophobia, and decreased vision are reported by patients with both primary and secondary HSV ocular infection, these symptoms are usually mild during the primary infection and are accompanied by signs and symptoms similar to an upper respiratory infection such as mild rhinitis, pharyngitis, fever, malaise, and a generalized skin rash. An ulcerative or vesicular blepharitis (see Chapter 23) or an acute follicular conjunctivitis often occurs in patients with primary HSV infection. Although the preauricular lymph node often is swollen, the patient frequently reports no node tenderness. 

Unrecognized primary HSV keratoconjunctivitis is most commonly misdiagnosed as EKC because of the follicular conjunctivitis, lymphadenopathy and corneal changes. One clinical feature that is helpful in making the diagnosis is the tendency for primary HSK to be unilateral and EKC to be bilateral. 

Recurrent HSK has accompanying lid and conjunctival involvement in about 31% of cases. This involvement typically appears as unilateral follicular conjunctivitis with moderate to severe diffuse conjunctival hyperemia. The initial epithelial lesions of HSK are small vesicles that are generally described as punctate epithelial keratopathy. Although dendritic or ameboid keratitis is the most common manifestation of HSK (Figure 26-47), a diffuse... 

There is anecdotal evidence implicating Chlamydia spp. in some cases of follicular conjunctivitis, and both Moraxella equi some Mycoplasma spp. may be involved in external ocular disease in the horse (Lavach 1990). The role of anaerobes in equine ocular disease has not been investigated extensively, although Clostridium perfringens has been isolated from corneal ulcers in two horses (Rebhun et al 1999). 

Sensory systems Eyes When conjunctival and corneal intraepithelial neoplasia were treated with topical interferon alfa-2b there was complete clinical resolution in 27 of the 28 eyes treated after a median of 2 months adverse reactions included mild conjunctival hyperemia and follicular conjunctivitis in three patients [39. ... 

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