Follicular conjunctivitis

If the mucous membrane of the eye becomes inflamed with the appearance of bubble formations - the follicle (from the Latin folliculus - pouch), then this is nothing more than follicular conjunctivitis. According to ICD-10, the code for the acute form of the disease is H10.019, the chronic one is H10.439.

Epidemiology

According to statistics, in 80% of cases, the cause of acute conjunctivitis, including follicular, are viruses, while adenoviruses account for 65-90% of cases.

The number of cases of acute follicular conjunctivitis caused by HSV ranges from 1.3-4.8% of all cases of acute conjunctivitis.

Causes of the follicular conjunctivitis

According to the form of the inflammatory process, this type  of conjunctivitis  can be acute and chronic, and its types are determined by etiology.

So, the causes of the acute form of follicular conjunctivitis include:

• respiratory adenoviruses  by more than two dozen seropits, causing adenoviral conjunctivitis and  epidemic keratoconjunctivitis ;
• HSV1 (herpes simplex virus) and Varicella zoster virus (herpes virus type 3 or chickenpox virus), the defeat of which leads to acute  herpetic conjunctivitis . [1]

The main causes of chronic follicular conjunctivitis are recognized:

• chlamydial infection - the bacterium Chlamydia trachomatis; [2]
• viral infection of the skin -  molluscum contagiosum , that is, damage to the skin of the eyelids, their edges and the mucous membrane of the eyes  with poxvirus  (Molluscum contagiosum virus), which is transmitted by contact or through infected objects. [3]

Chronic inflammation of the conjunctiva may be associated with an allergy to topical ophthalmic drugs: eye drops (Prozerin, Pilocarpine, Dipivefrin,  [4] Carbachol, Atropine, Brinzolamide  [5] , etc.) or antiviral solutions injected into the conjunctival sac.

The same infections cause follicular conjunctivitis in children, more details in the publications:

Acute conjunctivitis in children

• Viral conjunctivitis in children
• Conjunctivitis and keratitis in children
• Herpes simplex virus and eye diseases in children

Risk factors

The most serious risk factor for developing infectious conjunctivitis is direct contact with exudate released from the patient's eyes or indirect contact, for example, through a towel or pillowcase on a pillow.

Common factors also include: inadequate personal hygiene; reduced immunity; the presence of such ophthalmic diseases as blepharitis, dry eye syndrome, inflammation of the meibomian glands of the eyelids or nasolacrimal duct; improper use of contact lenses, as well as long-term use of some eye drops.

Pathogenesis

In follicular conjunctivitis of viral origin, the pathogenesis is due to the fact that viral particles (virions) penetrate the cytoplasmic membranes of epithelial cells into the cytoplasm and cell nuclei. After the introduction of the viral nucleocapsid containing its genome (RNA or DNA), the structure of the cells of the mucous epithelium of the conjunctiva is disturbed, the virus begins to multiply: its DNA is transcribed and replicated in the cell nuclei.

At the same time, some of the new virions are released from the nuclei and infect other cells, which leads to the activation of immunocompetent epithelial cells - T-lymphocytes, which destroy virus-infected cells.

As studies have shown, subconjunctival infiltrates in the form of follicles formed as a result of inflammation are clusters of lymphocytes.

Symptoms of the follicular conjunctivitis

In most patients, the first signs of follicular conjunctivitis are  redness of the eyes  and a feeling of sand in the eyes.

When the conjunctiva is affected by adenovirus, the incubation period - from the moment of infection to the stage of onset of symptoms of inflammation - lasts approximately 10 days, and the duration of the disease can be 7-28 days.

The main symptoms are tearing and watery discharge (with  chlamydial conjunctivitis  - mucopurulent), swelling of the eyelids and diffuse swelling of the conjunctiva (chemosis), intolerance to bright light (photophobia), blurred vision.

On the vaults of the conjunctiva (fornix conjunctivae), pronounced bubble (papillary or vesicular) formations of a rounded shape, 0.5-1.5 mm in diameter, appear.

Acute herpetic conjunctivitis, accompanied by itching and burning of the eyes, can have two forms: follicular and vesicular-ulcerative - with blisters on the eyelids (and serous discharge from them).

In the acute form, the lesion is often unilateral, but infection of the second eye occurs within a few days. In almost half of the cases, there is an increase in the lymph nodes located in front of the ears and their pain during palpation examination - preauricular lymphadenopathy.

If the pharynx is simultaneously inflamed (that is, there is pharyngitis with sore throat), an increase in body temperature is observed, which is defined as pharyngeal-conjunctival or  pharyngoconjunctival fever .

Complications and consequences

A complication of herpetic keratoconjunctivitis is inflammation of the cornea of the eyes and the development of  herpetic keratitis .

The consequence of chronic follicular conjunctivitis caused by chlamydia can be  trachoma  - with inflammation of the superficial vessels of the cornea and its clouding.

Diagnostics of the follicular conjunctivitis

Follicular conjunctivitis is a clinical diagnosis and is diagnosed by a thorough eye examination,  examination of the conjunctiva  , and appropriate laboratory tests.

To determine the infection, tests are needed: a swab from the eye (bakposev of the secreted exudate) and scraping from the conjunctiva, a complete blood count, a blood test for antibodies to HSV1 and other viruses.

Differential diagnosis

Differential diagnosis is carried out with other types of conjunctivitis, as well as ophthalmic diseases that have similar symptoms (anterior uveitis, scleritis, etc.).

Treatment of the follicular conjunctivitis

Treatment of follicular conjunctivitis caused by chlamydia includes not only topical agents, but also oral antibiotic therapy using tetracycline and erythromycin.

The main drugs for topical use:

• Eye drops for conjunctivitis
• Ointments for conjunctivitis

With inflammation of the mucous membrane of the eyes caused by hepreviruses, ophthalmologists prescribe Trifluridine eye drops (Trifluoridin, Lansurf, Viroptik) - one drop every two hours, and after three to four days - five times a day; eye gel Ganciclovir (Virgan) - up to five times a day. Betadine (5% solution) is used - for lubrication of the conjunctiva three times during the day.

Oral medications include Acyclovir 0.4 g three times a day, Valaciclovir ( Valtrovir ) 0.5 mg, or Famciclovir 0.25 g three times a day.

For the treatment of adenoviral conjunctivitis, antiviral treatment is not recommended, supportive measures to relieve symptoms include agents such as  artificial tears  or antihistamine drops (Cromohexal, Vizin, Opanadol, etc.), as well as cold compresses

On the recommendation of a doctor, additional treatment with herbs is possible, for more details see -  Herbs for washing eyes

In cases of damage by molluscum contagiosum, surgical treatment can be performed - curettage, which is a mechanical removal of the affected layer of mucous tissue.

Prevention

In the case of any conjunctivitis of infectious origin, preventive measures are the observance of the rules of personal hygiene, first of all, the cleanliness of the hands.

Hands should always be washed with soap and if there has been contact with a person who has conjunctivitis, hands should be treated with an alcohol-based disinfectant.

Forecast

With follicular conjunctivitis, the prognosis for the vast majority of patients is favorable.