Cicatricial Conjunctivitis and Concurrent Clinical Features: A Case Study

PURPOSE: We report a case of cicatricial conjunctivitis to illustrate the clinical approach for management of such a case. This is a 52-year-old Chinese man who presented with bilateral red eyes associated with itching for a year. He had a history of chronic itchy rash in the chest and the arms. Otherwise there was no history of autoimmune disease, asthma, sinusitis, or drug allergy. On examination, he had diffuse hyperemia over both conjunctivae, with symblepharon involving the inferior bulbar and palpebral conjunctivae, associated with cicatrization of the caruncles, and obliteration of inferior lacrimal puncta. There were mild subtarsal papillary reaction with Meibomian gland dysfunction and presence of inferior mis-directed eyelashes. The corneas showed multiple foci of superficial epitheliopathy. A clinical diagnosis of chronic cicatricial conjunctivitis was made, with differential diagnosis of chronic atopic allergic conjunctivitis. Conjunctival biopsy was performed from the inferior conjunctival adhesions and it showed patchy chronic stromal inflammation with focal lymphoplasmacytic sub-epithelial infiltrates and loss of goblet cells. The stroma shows marked fibrosis, with no evidence of mast cells or eosinophils. In particular, there were no deposits of IgA, IgM, C3, and fibrinogen in the basement membrane. The patient was treated with topical loteprednol, glucocorticoids and artificial tears, and his symptoms improved after treatment. CONCLUSION: We present a man with cicatricial conjunctivitis with chronic subconjunctival inflammation and fibrosis but no immune deposits in the conjunctival basement membrane on histology, to illustrate the clinical approach and diagnostic challenges in managing such a case.