ACUTE FOLLICULAR CONJUNCTIVITIS

Acute follicular conjunctivitis is an acute catarrhal conjunctivitis"OR KNOWN AS ACUTE MUCOPURULENT CONJUNCTIVITIS" associated with marked follicular hyperplasia especially of the lower fornix and lower palpebral conjunctiva.

General clinical features
Symptoms are similar to acute catarrhal conjunctivitis and include: redness, watering, mild mucoid discharge, mild photophobia and feeling of
discomfort
and foreign body sensation.

Signs are conjunctival hyperaemia, associated with multiple follicles, more prominent in lower lid than the upper lid (Fig. 1).

Fig. 1. Signs of acute follicular conjunctivitis.

 

Etiological types
Etiologically, acute follicular conjunctivitis is of the
following types:

• Adult inclusion conjunctivitis (visit this link plz).
• Epidemic keratoconjunctivitis (discussed below)
• Pharyngoconjunctival fever (discussed below)
• Newcastle conjunctivitis (discussed below)
• Acute herpetic conjunctivitis. (discussed below)

Epidemic Keratoconjunctivitis (EKC)
It is a type of acute follicular conjunctivitis mostly associated with superficial punctate keratitis and usually occurs in epidemics, hence the name EKC.

Etiology. EKC is mostly caused by adenoviruses type 8 and 19. The condition is markedly contagious and spreads through contact with contaminated fingers, solutions and tonometers.

Clinical picture. Incubation period after infection is about 8 days and virus is shed from the inflamed eye for 2-3 weeks.

Clinical stages. The condition mainly affects young adults. Clinical picture can be arbitrarily divided into three stages for the purpose of description only.

• The first phase is of acute serous conjunctivitis which is characterised by non-specific conjunctival hyperaemia, mild chemosis and lacrimation.
• Soon it is followed by second phase of typical acute follicular conjunctivitis, characterised by formation of follicles which are more marked in lower lid.
• In severe cases, third phase of 'acute pseudomembranous conjunctivitis' is recognised due to formation of a pseudomembrane on the conjunctival surface (Fig. 2).
• Corneal involvement in the form of 'superficial punctate keratitis', which is a distinctive feature of EKC, becomes apparent after 1 week of the onset of disease.
• Preauricular lymphadenopathy is associated in almost all cases.\

  

  Fig. 2. Pseudomembrane in acute epidemic keratoconjunctivitis
  (EKC)

  
  

Treatment. It is usually supportive. Antiviral drugs are ineffective. Recently, promising results are reported with adenine arabinoside (Ara-A). Corticosteroids should not be used during active stage.

Pharyngoconjunctival fever (PCF)
Etiology. It is an adenoviral infection commonly associated with subtypes 3 and 7.

Clinical picture. Pharyngoconjunctival fever is characterised by an acute follicular conjunctivitis, associated with pharyngitis, fever and preauricular
lymphadenopathy. The disease primarily affects children and appears in epidemic form. Corneal involvement in the form of superficial punctate
keratitis is seen only in 30 percent of cases.

Treatment is usually supportive.

Newcastle conjunctivitis
Etiology. It is a rare type of acute follicular conjunctivitis caused by Newcastle virus. The infection is derived from contact with diseased owls; and thus the condition mainly affects poultry workers.

Clinically the condition is similar to pharyngoconjunctival fever.

Acute herpetic conjunctivitis
Acute herpetic follicular conjunctivitis is always an accompaniment of the 'primary herpetic infection', which mainly occurs in small children and in
adolescents.

Etiology. The disease is commonly caused by herpes simplex virus type 1 and spreads by kissing or other close personal contacts. HSV type 2 associated with
genital infections, may also involve the eyes in adults as well as children, though rarely.

Clinical picture. Acute herpetic follicular conjunctivitis is usually a unilateral affection with an incubation period of 3-10 days. It may occur in two
clinical forms the typical and atypical:
In typical form, the follicular conjunctivitis is usually associated with other lesions of primary infection such as vesicular lesions of face and lids.

In atypical form, the follicular conjunctivitis occurs without lesions of the face, eyelid and the condition then resembles epidemic keratoconjunctivitis.
The condition may evolve through phases of non-specific hyperaemia, follicular hyperplasia and pseudomembrane formation.

Corneal involvement, though rare, is not uncommon in primary herpes. It may be in the form of fine or coarse epithelial keratitis or typical dendritic
keratitis.

Preauricular lymphadenopathy occurs almost always.

Treatment. Primary herpetic infection is usually selflimiting.
The topical antiviral drugs control the infection effectively and prevent recurrences.