Chronic Follicular Conjunctivitis Research Articles

Zoonotic transmission of Chlamydia felis from domestic cats; A case series of chronic follicular conjunctivitis in humans

We present three cases of chronic follicular conjunctivitis resulting from the zoonotic transmission of Chlamydia felis from domestic cats. Our objective is to raise awareness regarding the potential zoonotic transmission of Chlamydia felis from domestic cats and describe the methodology for definitive pathogen identification using Polymerase Chain Reaction (PCR) and subsequent sequence analysis, a useful tool in the identification of these rare pathogens. We discuss the factors that could be contributing to the potential under-diagnosis of zoonotic C. felis infections and propose a treatment regime for cases of C. felis-related conjunctivitis.

Observational Comparison of the Safety and Effectiveness of Myopic Children Wearing Defocus Incorporated Soft Contact Lenses or Orthokeratology Lenses

To observe and compare the effectiveness and safety of controlling myopia in children by wearing defocus incorporated soft contact (DISC) lenses or orthokeratology (OrthoK) lenses. A total of 75 children who came to our hospital between January 2018 and September 2020 were enrolled for this retrospective study. The DISC group consisted of 30 myopic children (60 eyes) wearing peripheral defocal soft incorporated contact lenses during daytime. There were 10 males and 20 females aged (9.9±1.00) years old in this group and their spherical equivalent refractions were (-2.78±0.70) D. The OrthoK group consisted of 45 myopic children (90 eyes) wearing OrthoK lenses. There were 30 female and 15 males aged (9.67±1.11) and their spherical equivalent refractions were (-2.67±0.71) D. All subjects had previously worn prescription glasses for 12 months or longer before they started wearing contact lenses. The subjects were followed up for 12 months once they started wearing contact lenses. The axial changes and corneal and conjunctival complications of the two groups of myopic children were compared and analyzed. Myopic children in both groups experienced relatively rapid increase in ocular axial length while they were wearing prescription glasses, with the ocular axial length increase in the prescription-glass-wearing period being (0.34±0.09) mm in the OrthoK group and (0.37± 0.07) mm in the DISC group. In the 12 months of wearing contact lenses, the ocular axial length of children in the OrthoK group increased by (0.18±0.04) mm, while that of the DISC group increased by (0.19±0.05) mm. The increase in ocular axial length was reduced in both groups after the children were switched to the new myopia prevention methods, showing significant difference ( P<0. 05). The two groups using two different contact lenses had similar axial length increase, showing no significant difference ( P>0.05). During the 12-month period while the subjects wore the two types of contact lenses, the incidence of chronic follicular conjunctivitis was 11.20% in the OrthoK group and 20.00% in the DISC group, with that of the DISC group being slightly higher without showing significant difference ( P>0.05). The incidence of grade-1corneal staining was 66.70% in the OrthoK group and 56.70% in the DISC group, and the incidence of grade-2 corneal staining was 17.80% in the OrthoK group and 16.70% in the DISC group. In other words, the OrthoK group had slightly higher findings, but the difference was not significant ( P>0.05). The incidence of contact lens-associated papillary conjunctivitis was 2.20% in the OrthoK group and 10.00% in the DISC group, which was slightly higher than that in the orthokeratology lens group, but the difference was not significant( P>0.05). Both DISC lenses and OrthoK lenses can effectively control the increase in axial length in myopic children, and their have better effects than those of prescription glasses. The two tyes of contact lenses showed similar effects for controlling axial length increase. Both contact lenses have fewer corneal and conjunctival complications and better safety.

Primary conjunctival follicular lymphoma mimicking chronic conjunctivitis

Clinical caseThe case is presented of a 43-year-old male patient with chronic follicular conjunctivitis, negative bacterial serology, and refractory to local treatment. The incisional biopsy performed showed to be consistent with reactive lymphoid hyperplasia. A year later, a new incisional biopsy showed follicular lymphoma, with no systemic involvement, and he was treated with local radiotherapy. DiscussionWhen a chronic follicular conjunctivitis is refractory to treatment, it is essential to perform an incisional biopsy to establish the histopathological diagnosis that can range from chronic inflammation, reactive lymphoid hyperplasia to lymphoma. Follicular lymphoma is rare among conjunctival lymphomas, and the staging is indispensable for the correct therapeutic approach.

Comparison of Direct Immunofluorescence (DIF) Method and Giemsa Staining with PCR Method for Detection of Chlamydia trachomatis in Patients with Follicular Conjunctivitis

Background: Chlamydia trachomatis is the most common cause of chronic follicular conjunctivitis. As a rapid diagnosis is important in the reducing the long-term squeal of the diseases, the objective of this study was to compare the three methods, direct immunofluorescence (DIF), staining and PCR, for detection of Chlamydia trachomatis in patients with follicular conjunctivitis. Material and methods: Overall 90 patients with conjunctival were enrolled in this study smears were prepared for DIF and Giemsa staining. PCR amplification after Extraction performed using CT1 and CT5 primers designed from Omp1 gene. Results: Of the 90 patients, 28 (31.1%) were positive by DIF and 13 (14.4%) by Giemsa staining; and 35 patients (38.8%) showed positive results in PCR. Sensitivity, specificity, predictive positive value, and negative predictive value of DIF in comparison to PCR respectively were calculated as 88.33, 100, 100 and 88.70. Sensitivity, specificity, predictive positive value and negative predictive value of DIF in comparison to PCR respectively were calculated as 61.40, 100, 100 and 71.42. Therefore, sensitivity and negative predictive value of DIF are significantly higher than Giemsa staining. Conclusion: DIF is more sensitive and more reliable than Giemsa staining for detection of Chlamydia trachomatis in the conjunctiva samples of patients with follicular conjunctivitis.

Linfoma folicular primario de la conjuntiva simulando conjuntivitis crónica

Clinical caseThe case is presented of a 43 year-old male patient with chronic follicular conjunctivitis, negative bacterial serology, and refractory to local treatment. The incisional biopsy performed showed to be consistent with reactive lymphoid hyperplasia. A year later, a new incisional biopsy showed follicular lymphoma, with no systemic involvement, and he was treated with local radiotherapy. DiscussionWhen a chronic follicular conjunctivitis is refractory to treatment, it is essential to perform an incisional biopsy to establish the histopathological diagnosis that can range from chronic inflammation, reactive lymphoid hyperplasia to lymphoma. Follicular lymphoma is rare among conjunctival lymphomas, and the staging is indispensable for the correct therapeutic approach.

Topical Cyclosporine A 1% for the Treatment of Chronic Follicular Conjunctivitis.

To evaluate the use of topical cyclosporine A (CSA) 1% in the treatment of chronic follicular conjunctivitis (CFC). Retrospective chart review from 2001 to 2012 identified 12 patients (22 eyes) with CFC (mean ± standard deviation [SD] age, 50.2 ± 15.4 years; 75% female; 92% white) treated with CSA. Main outcome measures included inflammation grade, visual acuity, concurrent corticosteroid (CS) therapy, effect on CS taper, and adverse effects. Mean ± SD follow-up time was 11.7 ± 9.7 months. Mean ± SD time from diagnosis to CSA treatment initiation was 2.4 ± 3.2 months. Mean ± SD duration of CSA treatment was 5.8 ± 2.8 months. Four patients (33%) complained of irritation (n = 2), redness (n = 1), itching (n = 1), and burning (n = 1) but none discontinued treatment. Concurrent CSs were tapered off in all patients after a mean ± SD of 5.0 ± 2.5 weeks. Mean ± SD initial vision was 0.078 ± 0.093 logMAR, whereas vision at final examination was 0.056 ± 0.081 logMAR (P = 0.02). Mean ± SD initial inflammation grade of 1.9 ± 1.0 was significantly reduced to final grade of 0.7 ± 0.9 (P = 0.0002). Mean ± SD time to initial inflammation control in 9 patients (75%) was 33.2 ± 24.5 days. Two patients (17%) switched to oral CSA because of lack of inflammation control. Topical CSA 1% is an effective and well-tolerated therapy that decreased chronic inflammation and tapered topical CS in patients with CFC. The use of CSA in such patients warrants further investigation.

Topical cyclosporine a 1% for the treatment of chronic ocular surface inflammation.

To evaluate the use of topical cyclosporine A (CsA) 1% emulsion in the treatment of chronic ocular surface inflammation (OSI). We conducted a retrospective chart review of patients with various forms of OSI treated with topical CsA 1% from 2001 to 2012. Twenty-nine patients (52 eyes) with various forms of OSI, including epidemic keratoconjunctivitis (n=14), chronic follicular conjunctivitis (n=12), Thygeson superficial punctate keratopathy (n=2), and vernal keratoconjunctivitis (n=1), were included. Twenty-seven patients had inflammation refractory to prior therapies. Twenty-four patients received concurrent medications with CsA 1%. Twenty-three of 24 patients on concurrent corticosteroids (CS) were able to taper their use while receiving CsA 1%. Thirteen patients experienced ocular discomfort with CsA 1%; one patient discontinued therapy all together as a result of these side effects; another switched to CsA 0.5% with improvement of adverse symptoms. Inflammation was controlled in 22 (92%) of the 24 patients who received CsA 1% for at least 2 months in duration. Topical CsA 1% helps to control inflammation and spares CS use in patients with chronic OSI.

Ocular Rhinosporidiosis Presenting as Chronic Follicular Conjunctivitis in a Contact Lens Wearer

Ocular Rhinosporidiosis Presenting as Chronic Follicular Conjunctivitis in a Contact Lens Wearer

Tracoma: estudo epidemiológico de escolares em Alagoas - Brasil

To define the detection rate of trachoma in scholars from Alagoas--Brazil.The sample included 6,424 children and adolescents. Scholar's clinical evaluation was performed by medical students under the supervision of professors of the Department of Ophthalmology, according to the World Health Organization guidelines. The clinical evaluation was characterized by eyelashes, eyelids, conjunctiva and cornea examination in both eyes. The scholars were cataloged and data of name, sex, age, clinical forms diagnosis and city were recorded. Regarding the age, the students were divided into three groups: group A (<10 years old), group B (10-14 years old) and group C (>14 years old).The detection rate of trachoma was 4.5%. From 3,280 male scholars, 161 (4.9%) cases were confirmed; from 3,144 female scholars, 131 (4.2%) cases were considered confirmed. From the total scholars in group A, B and C; respectively 175 (5.3%), 113 (8.0%) and 4 (1.6%) were considered confirmed cases.In this region, it seems that trachoma has not been eradicated and, therefore, must remain as a differential diagnosis of chronic follicular conjunctivitis in children and adolescents from this region.

Conjuntivitis folicular crónica en el lactante

A case of chronic follicular conjunctivitis in an infant presenting with ptosis and dacryorrhea is reported. Polymerase chain reaction (PCR) test identified Chlamydia trachomatis as the causative agent. The patient was treated with topic and systemic erythromycin. The infection was probably transmitted during delivery. Chronic follicular conjunctivitis in infants is very uncommon in our environment. The most sensitive and specific diagnostic test is PCR. It is necessary to identify the original focus of infection and to provide specific treatment to all the carriers as soon as possible to avoid and prevent chronic complications.

Conjunctival Non-Caseating Granulomas in a Human Immunodeficiency Virus (HIV) Positive Patient Attributed to Sarcoidosis

Purpose: To report a rare case of isolated ocular sarcoidosis in an HIV positive patient. Design: Case report. Methods: A 47-year-old HIV+ Caucasian male was referred for chronic bilateral follicular conjunctivitis. Results: A conjunctival biopsy that was performed on the right eye showed sarcoidosis. General medical evaluation including a spiral thin cut chest CT scan revealed no systemic involvement. The ocular signs and symptoms resolved completely with topical corticosteroid treatment. Conclusions: HIV infection and sarcoidosis rarely coexist, presumably because their immunopathogenesis mechanisms diverge. In the absence of systemic involvement, a definite diagnosis can only be made by biopsy of the ocular tissues.

Topical Tacrolimus Ointment for Treatment of Refractory Anterior Segment Inflammatory Disorders

To report 4 cases of patients treated with topical tacrolimus ointment 0.03% for ocular inflammatory conditions refractory to traditional treatment. Four patients were treated topically with tacrolimus 0.03% ointment twice daily: 2 patients with blepharokeratoconjunctivitis, 1 patient with severe atopic keratoconjunctivitis, and 1 patient with chronic follicular conjunctivitis. Three patients had a dramatic improvement of their ocular condition as early as 2 weeks after starting tacrolimus ointment. One patient developed a herpes simplex virus dendrite after 1 week of tacrolimus use. Tacrolimus ointment appears to be an effective alternative for certain ocular inflammatory conditions refractory to traditional treatments. There may be an increased risk of herpes simplex virus keratitis associated with topical use. Our results support previous literature of patients benefiting from topical tacrolimus use.

Current trachoma treatment methodologies: focus on advancements in drug therapy.

Currently, there are approximately 6 million people with irreversible blindness as a result of chronic follicular conjunctivitis with subsequent corneal scarring caused by Chlamydia trachomatis, also known as trachoma. On the basis of the clinical studies evaluated, the most widely tested effective pharmacological treatments for trachoma today are topical tetracycline 1% to be applied to both eyes twice daily for 6 weeks or a single oral dose of azithromycin 20 mg/kg (up to 1g). Although chemotherapy can generate prompt therapeutic response and surgery can reverse the repercussions of these infections, these conditions will persist through reinfections. Implementing proper personal hygiene and environmental improvement measures for the control of infection transmission will be essential in reducing the potentially devastating results of trachoma infections.

Prevalence of Chlamydia Trachomatis Pooled Serotypes BDE and FGK in Children with Chronic Follicular Conjunctivitis

Purpose: To evaluate type-specific antichlamydial antibody IgG in children with chronic follicular conjunctivitis. Methods: A total of 90 serum samples from juvenile patients with chronic follicular conjunctivitis were collected in the Southeastern Anatolian region of Turkey where trachoma is still endemic. These samples were investigated regarding Chlamydia trachomatis pooled serotype-specific IgG by using the micro-immunofluorescence test. A titer of 1/32 or higher was considered positive. Results: Specific IgG seropositivity to Chlamydia trachomatis titer was found in 33 (36.1%) of the 90 subjects. A higher titer was observed frequently in the serotypes pooled in BDE (21 subjects), CHIJ (10 subjects), and FGK (2 subjects), respectively. Conclusions: The presence of antichlamydial antibodies in blood should always be interpreted in accordance with the history of the patient, the clinical picture, and the course of the disease. In the diagnosis of Chlamydia trachomatis infections in a patient with chronic follicular conjunctivitis, not only genus-specific antibodies but also the presence of the subspeciespecific antibodies should be investigated.

Immunopathogenesis of conjunctival scarring in trachoma.

Trachoma, a chronic follicular conjunctivitis caused by infection with Chlamydia trachomatis, is the leading cause of preventable blindness. The blinding complications are associated with progressive conjunctival scarring that may result from immunologically mediated responses. We studied the processes involved in the regulation of inflammation and fibrosis in trachoma by investigating the expression of fibrogenic cytokines in the conjunctiva. We studied conjunctival biopsy specimens obtained from nine subjects with active trachoma and from four control subjects. We used immunohistochemical techniques and a panel of monoclonal and polyclonal antibodies directed against interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), tumour necrosis factor-alpha (TNF-alpha) and platelet-derived growth factor (PDGF). In addition, we characterised the composition of the inflammatory infiltrate by the use of a panel of monoclonal antibodies. Sirius red and Van Gieson stains were used to characterise the extent of fibrous tissue in the substantia propria. Trachoma specimens showed greater numbers of inflammatory cells than control specimens. The expression of cytokines was absent in the normal conjunctiva. Cytoplasmic IL-1 alpha and IL-1 beta expression was noted in the conjunctival epithelium in all trachoma specimens. IL-1 alpha, IL-1 beta, TNF-alpha and PDGF were detected in macrophages infiltrating the substantia propria. B lymphocytes predominated over T lymphocytes in six trachoma biopsies with fibrosis confined to the deep substantia propria, whereas T lymphocytes predominated over B lymphocytes in three biopsies with more extensive fibrosis. In all trachoma biopsies helper/inducer T lymphocytes outnumbered suppressor/cytotoxic T lymphocytes. The upregulated local production of IL-1 alpha, IL-beta, TNF-alpha and PDGF might contribute to conjunctival damage and scarring in trachoma.

Evaluation of two nonculture antigen tests and three serotests for detection of anti-chlamydial antibodies in the diagnosis of ocular chlamydial infections

Diagnosis of chlamydial conjuctivitis is difficult in chronic diseases because chlamydial elementary bodies are mostly undetectable in conjunctival scrapings by cell culture. We therefore compared two nonculture antigen tests and three different serotests for anti-chlamydial antibodies with McCoy cell culture, the "gold standard" of chlamydial diagnosis. Conjunctival scrapings and serum samples of 93 patients attending the outpatient eye clinic in Graz because of chronic follicular conjunctivitis were tested. A total of 558 conjunctival scrapings and 93 serum samples were investigated. Chlamydial antigen detection was done by McCoy cell culture, polymerase chain reaction (PCR; Amplicor, Roche), and direct immunofluorescence assay (DFA; Microtrak, Syva). Antichlamydial IgA and IgG antibodies in the sera were detected by an immunoperoxidase assay (IPAzyme, Savyon) and two different enzyme-linked immunosorbent assays (SeroELISA, Savyon and rELISA, medac). Cell culture and PCR yielded identical results. The positivity rate for chlamydial conjunctivitis was 8.6% (8 of 93 patients). PCR proved most sensitive and most specific. IPAzyme was 75% sensitive for IgA and 100% for IgG; SeroELISA and rELISA were less sensitive. IPAzyme was 81% specific for IgA and 47.3% for IgG. SeroELISA and rELISA were less specific for IgA, but more specific for IgG. Post-test likelihood of disease was greatest in IPAzyme. PCR proved to be a good alternative to cell culture; DFA is useful for quick diagnosis. Genus-specific serotests cannot compete with chlamydial antigen detection. They differ in sensitivity and specificity because of the antigen type they present. They are still of only supportive value in cases where chlamydial antigen detection is not possible. Recently introduced species-specific antibody tests should be of greater value.

Experimental conjunctival infection of lambs with a strain of Chlamydia psittaci isolated from the eyes of a sheep naturally affected with keratoconjunctivitis.

Five ram-lambs were inoculated into the left conjunctival sac with the 15R isolate of Chlamydia psittaci, recovered from a sheep with keratoconjunctivitis. A sixth ram-lamb was kept in contact with them. The five lambs developed varying degrees of acute conjunctivitis and 14 days later C psittaci could be recovered from the inoculated eyes, from which Branhamella ovis was also isolated. The eyes were examined regularly for four months; C psittaci could not be re-isolated but the eyes developed varying degrees of follicular conjunctivitis. After four months the sheep were treated with corticosteroids in an attempt to reactivate a latent chlamydial infection but no chlamydiae could be isolated. Five months after the start of the experiment the six lambs were inoculated with 15R into the left conjunctival sacs. Acute conjunctivitis developed which was not as severe as after the first inoculation, but C psittaci could only be recovered from the left eyes of three sheep three days after inoculation. The eyes remained chronically affected by follicular conjunctivitis. Six months after the start of the experiment the left eyes were again inoculated with 15R; on this occasion acute conjunctivitis did not develop and chlamydiae could not be isolated. Chronic follicular conjunctivitis persisted until the experiment was terminated three months later.

Treatment of Periorbital Molluscum contagiosum by Incision and Curettage

Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young adults. In children, infection is spread by direct contact or through fomites, with lesions predominating on the trunk, extremities, and face. In young adults, this disease is spread primarily through sexual contact. Periocular infection can cause secondary chronic follicular conjunctivitis, superficial keratitis, and punctal occlusion. Although many modes of therapy are effective in destruction of the virus, some may have significant side effects when used in the periocular area. We describe treatment by incision and curettage, which we recommend as a simple, effective method of managing this problem.

The diagnosis and treatment of chlamydial conjunctivitis.

Chlamydial conjunctivitis will usually go unrecognized and therefore untreated unless it is specifically considered. The possibility of chlamydial infection must be borne in mind in neonatal conjunctivitis, in acute conjunctivitis in sexually active adults, and in chronic follicular conjunctivitis. Chlamydial conjunctivitis is often indistinguishable from other forms of conjunctivitis on clinical grounds, and accurate diagnosis is based on laboratory tests. It seems that direct fluorescent antibody (DFA) cytology offers an attractive alternative to the more complicated and time-consuming tissue culture isolation method. Once diagnosed, chlamydial infection should be treated with the appropriate systemic antibiotics, and proper posttreatment follow-up is necessary to assess the efficacy of treatment.

Moraxella lacunata isolated from epidemic conjunctivitis among teen-aged females.

An epidemic follicular conjunctivitis affecting teen-aged females has been studied. Moraxella lacunata was isolated from 11% of the patients, a frequency far above the rate found in other types of chronic conjunctivitis. The condition is suggested to be the chronic follicular conjunctivitis (Axenfeld) due to Moraxella lacunata.