Follicular Conjunctivitis

What is Follicular Conjunctivitis?

Follicular conjunctivitis is the swelling or inflammation of the conjunctiva in the eye. Conjunctivitis is also 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. 

Follicular conjunctivitis features rounded nodules of grey-white follicles in the conjunctiva. Follicles turn pale on the surface and red at the base due to a collection of lymphocytes. These are white blood cells in the immune system.

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 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, such as brimonidine
• Bacterial infections
• Viral infections

This type of infection can have two clinical forms: 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 that causes a reddish-pink eye
• Chemosis. Fluid collection in the eye that causes swelling and gives a “big blister” appearance
• Watery 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.

An eye doctor will perform an eye exam and lab testing. They may also look for molluscum lesions and determine whether they cause recurrence.

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

A diagnosis can also 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

Treatment For Follicular Conjunctivitis 

Treatment for follicular conjunctivitis is based on the cause of infection. Your options include:

Antibiotics

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.

Professional Treatment

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. 

Home Remedies

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.

How to Prevent Follicular Conjunctivitis

Here are some tips on how to prevent follicular conjunctivitis:

• Wash your hands with soap and water frequently
• Avoid touching your eyes, and make sure your hands are clean if you must touch them
• Don't share towels, razors, toothbrushes, makeup, or other personal items 
• Replace or disinfect any eye products that you've used on infected eyes
• Store and handle your contact lenses properly and replace them when they expire

Summary

Follicular conjunctivitis causes swelling of the eyelids and surrounding tissues. It's important to seek proper treatment as soon as possible. Failing to treat the condition can lead to the recurrence of infection, scarring, or blindness.