Follicular Conjunctivitis

6 sources cited
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What is Follicular Conjunctivitis?

Follicular conjunctivitis is the swelling or inflammation of the conjunctiva in the eye. Conjunctivitis is commonly known as "pink eye."

The conjunctiva is a fine, transparent layer of tissue. It borders the inner eyelid and spans the sclera. The sclera is the white ocular surface. 

Fovea eye anatomy

There are many causes of follicular conjunctivitis including:1

  • Viruses
  • Atypical bacteria
  • Toxins

Some of these toxins include topical medications. For example, brimonidine. Brimonidine is a type of glaucoma drug.

Follicular conjunctivitis looks like “pink eye.” Some cases are acute, such as viral conjunctivitis.

Others may be chronic. For example, toxic conjunctivitis. 

Follicular conjunctivitis features rounded nodules of grey-white follicles in the conjunctiva.

Follicles turn pale on the surface and red at the base. This is due to a collection of lymphocytes. These are white blood cells in the immune system.

follicular conjunctivitis

Without proper treatment, there is a risk of:

  • Recurrence of infection
  • Scarring
  • Blindness 

4 Types of Follicular Conjunctivitis

Follicular conjunctivitis can be acute or chronic. The cause of your disease will determine its classification.

There are several types of chronic follicular conjunctivitis:

1. Toxic follicular conjunctivitis

This is a toxic reaction to a specific topical medication.

An eye doctor performs lab tests to rule out chlamydial infection. Then you'll stop using the drug in question to see if there is an improvement.  

2. Trachoma

This eye disease is an infection. It's caused by the bacterium Chlamydia trachomatis.

Trachoma is more common in developing countries. Flies are the primary form of transmission. 

3. Inclusion conjunctivitis

This is a chlamydial infection in your eye. It's common in the developed world.

Inclusion conjunctivitis is a sexually transmitted infection that usually spreads through genital-eye contact.

Follicles in such conditions appear much larger than those observed in viral conjunctivitis.

4. Follicular conjunctivitis due to molluscum lesions

This eye condition appears in response to the molluscum contagiosum virus.

The virus causes lesions to form on and around the eyelid margins. These infect the conjunctiva and cause a follicular reaction.

In people living with HIV, lesions can be more widespread.

What Causes Follicular Conjunctivitis? 

In acute follicular conjunctivitis, the most common cause is viral.

Viral infections linked with acute cases of the eye condition include:

  • Epidemic keratoconjunctivitis 
  • Herpes zoster keratoconjunctivitis 
  • Infectious mononucleosis 
  • Epstein-Barr virus

Bacterial infections like chlamydia may also cause acute follicular conjunctivitis. In these cases, an eye doctor uses the term “inclusion conjunctivitis” to describe the condition.

Chronic follicular conjunctivitis can be caused by:

  • Reactions to topical medications
  • Bacterial infections
  • Viral infections

This type of infection can have two clinical forms. These are trachoma and inclusion conjunctivitis.

If inclusion conjunctivitis isn't treated correctly, infections can remain for more than three weeks. 

If trachoma isn't treated, blindness can occur.

Symptoms of Follicular Conjunctivitis

Symptoms of follicular conjunctivitis include the following:

  • Hyperemia. An excess of blood in the eye vessels. This symptom causes the reddish-pink eye.
  • Chemosis. Fluid collection in the eye. This symptom causes swelling and gives a “big blister” appearance
  • Watery discharge.
  • Pus discharge from the eye.
  • Photophobia. Exposure to light causes pain or discomfort in the eye.
  • Periorbital pain. Pain in, around, or behind the eye.

How is Follicular Conjunctivitis Diagnosed?

If you have any symptoms mentioned above, call your eye doctor immediately.

This diagnosis can help rule out all possible causes, such as:

  • Uveitis. Inflammation of the uveal tract.
  • Keratitis. an inflammatory eye condition that affects the cornea.
  • Foreign body. items such as dirt, eyelashes, or debris stuck in your eye.

If none of the above are the cause, they will move on to other tests. This helps determine what type of conjunctivitis it is.

In follicular conjunctivitis, the follicles are most noticeable in the inferior palpebral and forniceal conjunctiva. These are specific areas of the transparent membrane.

Your preauricular lymph node will often swell. This lymph node is in front of your ear.

Conjunctiva Anatomy

An eye doctor will perform an eye exam and lab testing. They may look for molluscum lesions to see if they are the cause for recurrence.

If these causes are not likely, a chlamydial infection may be present. Your eye doctor will send samples to the lab for confirmation.

If these causes are not likely, eye care clinicians may suspect a chlamydial infection (by C. trachomatis). They will send samples to the lab for confirmation.

Treatment For Follicular Conjunctivitis 

Treatment for follicular conjunctivitis is based on the cause of infection. 

In chlamydial infections, eye care clinicians may prescribe an oral antichlamydial antibiotic.

The most effective antibiotics of this type include:

  • Azithromycin
  • Doxycycline

However, the antibiotic regimen may also include tetracycline or erythromycin. All regular sexual partners should be treated to prevent the infection from reappearing.

In cases with molluscum lesions, an eye surgeon will remove the lesion. The surgeon will do this either by excision or curettage. These processes involve scooping or scraping tissue.

Topical medications do not work in such cases. 

For viral follicular conjunctivitis, eye doctors recommend patients stop wearing contacts. Most cases self-resolve within two weeks.

Other treatments include:

  • Frequent handwashing and disinfection
  • No use of cosmetic products 
  • Cold compress
  • Artificial tear eye drops

Eye care clinicians may prescribe topical corticosteroids. This treatment is in cases with photophobia and decreased vision.

Frequently Asked Questions (FAQs)

Can you go blind from conjunctivitis?

Follicular conjunctivitis can cause blindness. These infections are recurrent. They can cause scarring, leading to blindness.

However, this type of conjunctivitis is not common in developed countries like the United States.

Other types of follicular conjunctivitis do not cause blindness.

Seek treatment. An eye infection may suggest a more serious, underlying disease. 

What is the prognosis for follicular conjunctivitis?

The prognosis for follicular conjunctivitis is generally good. This is if patients seek proper treatment.

If not treated, the infection may reappear at a later time. This is the case for untreated chlamydial infection.

In trachoma cases, the prognosis could be worse without treatment. Scarring and corneal blindness may occur.

Is acute follicular conjunctivitis pink eye?

Acute follicular conjunctivitis can be pink eye. This is due to the reddening of the eyes.4

But not all pink eye cases will be acute follicular conjunctivitis.

Pink eye can also be a case of papillary conjunctivitis. The cause may be different.

Is follicular conjunctivitis contagious?

Follicular conjunctivitis can be contagious in some cases.

An example of this is inclusion conjunctivitis. This is caused by the bacteria Chlamydiae trachomatis.

This type of infection can spread to other people. This spread can occur via sexual transmission.

Epidemic keratoconjunctivitis is quite contagious.

It can be passed through tears, discharge from the eye of an infected person, or from touching your eye.

6 Cited Research Articles
  1. “Chronic Follicular Conjunctivitis.” Chronic Conjunctivitis, Part 1: Chronic Follicular Conjunctivitis
  2. “Follicular Conjunctivitis.” Follicular Conjunctivitis | Columbia Ophthalmology
  3. “Papillary Versus Follicular Conjunctivitis.” Clinical Education - Book Excerpts, American Academy of Ophthalmology
  4. Solano, Daniel. “Viral Conjunctivitis.” StatPearls [Internet]., U.S. National Library of Medicine, 30 Oct. 2020
  5. Azari, Amir A, and Amir Arabi. “Conjunctivitis: A Systematic Review.” Journal of ophthalmic & vision research vol. 15,3 372-395. 6 Aug. 2020
  6. Darougar, S et al. “Acute follicular conjunctivitis and keratoconjunctivitis due to herpes simplex virus in London.” The British journal of ophthalmology vol. 62,12 : 843-9
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