CASE REPORT
An 83-year-old man with irrelevant past medical history presented with intermittent bilateral ocular foreign body sensation and tearing for the last year, with no other associated symptoms.
The patient denied the use of any ocular medications except artificial tears. His past ocular history was remarkable for uneventful bilateral cataract extraction and intraocular lens insertion, three years before.
Visual acuity was 20/20 in his right eye and 20/25 in his left eye.
Slit lamp examination revealed both anterior and posterior severe blepharitis, discrete medial ectropion, and bilateral multiple confluent upper eyelid conjunctival concretions.
DISEASE
Conjunctival concretions are small, typically multiple, yellow–white lesions commonly found on the palpebral conjunctiva of elderly individuals and those with chronic inflammation. They are thought to be widespread and typically asymptomatic, occurring in 40-50% of studied populations.
The cause for these concretions is variable but most commonly associated with aging and chronic inflammation.
Long-standing inflammation, such as chronic conjunctivitis (e.g., trachoma or vernal), severe atopic conjunctivitis, and meibomian gland disease, have been associated with the formation of these concretions.
Conjunctival concretions have also been associated with the recrystallization of certain eye drops (e.g., sulfadiazine).
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From Choroida — the team behind this siteMANAGEMENT
Treatment is usually unnecessary because the concretions are asymptomatic and located in the subepithelial space.
If they erode through the epithelium, they can often be removed with needlepoint forceps or a 30 gauge needle after installation of topical anesthetic.
In cases of foreign body sensation or persistent irritation, they may be removed surgically.
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From Choroida — the team behind this siteREFERENCES
- Haicl P, Jankova H. “[Prevalence of conjunctival concretions].” Cesk Slov Oftalmol. 2005 Jul;61(4):260-4.
- Kulshrestha MK, Thaller VT. “Prevalence of conjunctival concretions.” Eye. 1995(9):797–798.
- Boettner EA, Fralick FB, Wolter JR. Conjunctival concretions of sulfadiazine. Arch Ophthalmol 1974;92:446.
- Chin, GN, Chi EY, Bunt AH. “Ultrastructural and histochemical studies of conjunctival concretions.” Arch Ophthalmol. 1980 Apr;98(4):720-4.
- Chang SW, Hou PK, Chen MS. “Conjunctival concretions. Polarized microscopic, histopathologic, and ultrastructural studies.” Arch Ophthalmol. 1990 Mar;108(3):405-7.
Test yourself
A few questions straight from this article.
-
What is the typical appearance of conjunctival concretions?
Conjunctival concretions are small, typically multiple, yellow-white lesions rather than solitary or pigmented masses. -
On which part of the conjunctiva are concretions most commonly found?
Concretions are commonly found on the palpebral conjunctiva, which is why they are seen on lid eversion at the slit lamp. -
In what proportion of studied populations do conjunctival concretions occur?
Conjunctival concretions are thought to be widespread and typically asymptomatic, occurring in 40-50% of studied populations. -
Which factors are most commonly associated with the formation of conjunctival concretions?
The cause is variable but concretions are most commonly associated with aging and with chronic ocular surface inflammation. -
Which topical drug has been linked to conjunctival concretions through recrystallization?
Conjunctival concretions have been associated with the recrystallization of certain eye drops, sulfadiazine being the reported example. -
Which chronic ocular surface conditions are linked to conjunctival concretion formation?
Long-standing inflammation such as trachoma, vernal or severe atopic conjunctivitis, and meibomian gland disease, has been associated with concretion formation. -
Why is treatment of conjunctival concretions usually unnecessary?
Most concretions cause no symptoms and sit in the subepithelial space, so they do not rub against the ocular surface. -
What prompts removal of a conjunctival concretion?
Concretions that erode through the epithelium, or that cause foreign body sensation and persistent irritation, are the ones removed. -
How is an eroded conjunctival concretion typically removed in clinic?
Once a concretion has eroded through the epithelium it can often be lifted out with needlepoint forceps or a 30 gauge needle after topical anaesthetic.
