Conjunctivitis: Chronic

Chronic Conjunctivitis: Definition & Overview - The Lingering Red Eye

• Conjunctival inflammation persisting >4 weeks.
• Presents with ongoing or relapsing symptoms.
• Common features:
  • Persistent hyperemia ("lingering red eye").
  • Chronic discomfort, foreign body sensation.
  • Scanty, often mucoid or mucopurulent discharge.
  • Mild itching or burning.
• Symptoms typically milder but more persistent than acute forms.

⭐ Chronic conjunctivitis may be associated with underlying factors like chronic blepharitis, dry eye, or low-grade infections.

Chronic Conjunctivitis: Etiology - Unmasking The Culprits

• Infective Agents:
  • Bacterial: Staphylococcus aureus (most common), Moraxella lacunata (angular conjunctivitis).
  • Chlamydial: Trachoma (C. trachomatis serotypes A-C), Inclusion Conjunctivitis (C. trachomatis serotypes D-K).
  • Viral: Molluscum contagiosum (eyelid lesions shedding virus).
  • Fungal/Parasitic: Rare; consider in immunocompromised or specific exposures.
• Allergic Reactions:
  • Vernal Keratoconjunctivitis (VKC).
  • Atopic Keratoconjunctivitis (AKC).
  • Giant Papillary Conjunctivitis (GPC) - e.g., contact lenses, sutures.
• Irritative/Toxic Factors:
  • Medications: Preservatives (e.g., BAK), chronic topical drug use.
  • Environmental: Smoke, dust, chemical fumes, pollutants.
  • Factitious conjunctivitis.
• Anatomic & Tear Film Issues:
  • Blepharitis / Meibomian Gland Dysfunction (MGD).
  • Eyelid malpositions: Entropion, ectropion, trichiasis.
  • Dry Eye Syndrome (KCS), Lagophthalmos.
• Associated Conditions:
  • Ocular Rosacea.
  • Ocular Cicatricial Pemphigoid.

⭐ Moraxella lacunata typically causes chronic angular conjunctivitis, often associated with maceration of the skin at the canthi.

Chronic Conjunctivitis: Key Types (Trachoma, VKC, OCP) - Clinical Clues Galore

Trachoma

• Agent: Chlamydia trachomatis (serotypes A, B, Ba, C) - leading cause of preventable blindness worldwide.
• 📌 SAFE Strategy: Surgery (for trichiasis), Antibiotics (e.g., Azithromycin), Facial cleanliness, Environmental improvement.
• Key Signs:
  • Arlt's line: Dense transverse scar in upper tarsal conjunctiva.
  • Herbert's pits: Limbal depressions, pathognomonic sequelae of resolved follicles.
  • Follicular & papillary hypertrophy in active stages.
• Simplified WHO Trachoma Grading (FISTO):

Vernal Keratoconjunctivitis (VKC)

• Chronic allergic conjunctivitis; recurrent, bilateral; affects young males, typically in spring/summer.
• Types: Palpebral (cobblestones), Limbal (Horner-Trantas dots), Mixed.
• Signs:
  • Cobblestone papillae: Giant papillae, typically on upper tarsal conjunctiva.
  • Horner-Trantas dots: Apical gelatinous collections of eosinophils at limbus.
  • Shield ulcer: Severe, non-infectious corneal ulcer.
• Symptoms: Severe itching (key symptom), photophobia, thick ropy discharge.

⭐ Horner-Trantas dots: pathognomonic limbal collections of eosinophils & epithelial cells in VKC.

Ocular Cicatricial Pemphigoid (OCP)

• Rare, chronic autoimmune blistering disease affecting conjunctiva & other mucous membranes.
• Progressive scarring leads to:
  • Symblepharon: Adhesions (between palpebral and bulbar conjunctiva).
  • Ankyloblepharon: Adhesion of eyelid margins.
  • Forniceal shortening, entropion, trichiasis.
  • Severe dry eye, corneal damage, potential blindness.
• 

Chronic Conjunctivitis: Management - Treatment Blueprints

• General: Identify & remove cause. Frequent lubrication (preservative-free preferred). Consistent lid hygiene if associated blepharitis.
• Specifics guided by etiology:

⭐ For Vernal Keratoconjunctivitis (VKC), topical cyclosporine A is a steroid-sparing agent effective in managing severe cases and preventing recurrences.

High‑Yield Points - ⚡ Biggest Takeaways

• Chronic conjunctivitis: Inflammation > 4 weeks.
• Trachoma (C. trachomatis A-C): Arlt's line, Herbert's pits; SAFE strategy crucial.
• Adult Inclusion Conjunctivitis (C. trachomatis D-K): Linked to genital infection; follicular response.
• VKC: Intense itching, Trantas dots, cobblestone papillae; typically young males.
• AKC: Affects older patients with atopy; risk of corneal scarring.
• GPC: Common in contact lens wearers; presents with giant papillae.
• Phlyctenular Keratoconjunctivitis: Hypersensitivity to microbial antigens (e.g., Staph).