Granulomatous conjunctivitis associated with chronic blepharitis in children

Abstract

AbstractPurpose To outline the clinical and pathological characteristics of granulomatous conjunctivitis associated with primary chronic blepharitis in childrenMethods 23 children presenting ocular rosacea with suspected conjunctival granulomas were examined prospectively. Conjunctival biopsies were performed in 20 patients; for each sample we associated histological study with an immunohistochemistry analysis (CD3, CD4, CD8, CD1a, CD11c, CD68, CD123).Results Conjunctival inflammation was micronodular, associated with follicles in 4 cases. Conjunctival granulomas appeared as whitish or subtle yellowish nodules. Corneal complications were common (87%), as phlyctenular lesions (43.5%) and neovascularization (69.5%). Epithelioid granulomas associated with giant cells infiltrated the conjunctival matrix of most patients (80%), inflammatory infiltrate only was found for 4 patients. The granulomatous specimens showed peri‐ and intra‐granulomas infiltration by inflammatory T‐cells (CD3), with more CD4 cells than CD8 cells, monocytic‐derived cells (CD11c) including macrophages (CD68+ CD1a), and less frequently plasmacytoid dendritic cells (CD123). Treatment included topical steroids, lubricants and eyelids care (100%), topical ciclosporine (13%), systemic antibiotics (35%).Conclusion Granulomatous conjunctivitis is a complication of ocular rosacea in children. The immunopathology of the conjunctiva identified the main cellular actors involved in the granulomatous process. Our results provide a new look on this pathology.