Granular conjunctivitis: causes, symptoms, diagnosis, treatment

To granular conjunctivitis are such common diseases as follicular conjunctivitis, trachoma and follicle. All these diseases have a common, purely external similarity, expressed in the development on the mucosa of the globular form of the follicle formations. By their origin, clinical manifestation, course and outcome, they are completely different.

The follicle is not a specific element of trachoma, as it was thought before. The follicle can arise as a typical reaction of the adenoid tissue of the conjunctiva to a wide variety of effects. Under the influence of various agents, adenoid tissue lymphoid cells are able to multiply, and where there were single cells, their clusters - new follicles are formed. The increase in lymphoid cells and follicles may be limited to the surface layer of the tissue, or their multiplication occurs throughout the adenoid layer. At the same time the friability of the adenoid layer is lost, it is replaced by a cellular infiltrate from the lymphoid cells, against which the number of follicles also increases.

[1], [2], [3], [4]

Follicle disease

Follicle - hyperplasia of lymphoid elements of adenoid tissue, clinically expressed in the formation of follicles. Follicles appear on the unchanged healthy conjunctiva. They are located mainly on the lower transitional fold, sometimes on the top. The follicles have a pale pink color and are superficially sometimes arranged in regular rows, like beads on a string. Folliculosis is observed, mainly, in children aged 8 to 15 years and is not a disease. This is the age state of the adenoid tissue. Simultaneously with conjunctival folliculosis in children, similar follicles are found on the mucous membrane of the posterior pharyngeal wall, and on enlarged tonsils. Children sleep with their mouths open, they do not breathe well due to hypertrophy of the nasopharyngeal adenoids. Subjective sensations of follicles do not cause and treatment does not require. Over time, hyperplasia of the adenoid tissue passes, the follicles completely disappear.

In adults, with increased sensitivity of the adenoid layer to external stimuli (airborne chemicals and suspended dust particles in the air) follicles may also appear on the moraine or slightly hyperemic conjunctiva. So, for example, in some people, after instillation of atropine on the conjunctiva, small superficially located follicles appear, which quickly disappear with the discontinuation of atropine instillation. From trahoma, follicles are easy to distinguish. In folliculosis, as it was said above, the follicles have a pale pink color and are superficially located on a completely unchanged healthy conjunctiva along the lower transitional fold.

[5], [6], [7], [8]

Follicular conjunctivitis

Follicular conjunctivitis is either infectious conjunctivitis, in which, in addition to the signs characteristic of them, follicles appear, or it is an infectious conjunctivitis that has developed against the background of the age-related condition of the adenoid tissue - follicle.

In the clinical picture, in addition to the follicles, infiltration and looseness of the conjunctiva are noted, separated, gluing eyelids per night. This condition is sometimes mistaken for trachoma. Clinical observations show that follicular conjunctivitis, unlike trachoma, does not leave scar changes in the conjunctiva and does not affect the cornea.

Histologically follicles in folliculosis and trachoma may be the same, but the essence of the trachomatous process is not only the presence of follicles, but also in their cyclicity, in those changes that occur in the conjunctiva and the cornea, in the diffuse cell infiltrate of the adenoid layer in follicles, connective tissue - scar.

[9], [10], [11]

Trachoma

Trachoma is a specific, communicable, chronic, infectious, usually bilateral, inflammation of the connective shell of the eyes, expressed by diffuse infiltration of it with the formation of follicles (grains), their degeneration, decay and subsequent scarring.