The giant fornix syndrome - An unrecognized cause of chronic, relapsing, grossly purulent conjunctivitis
ABSTRACT To describe a group of elderly patients presenting with chronic, relapsing, copiously purulent conjunctivitis, in which the condition was often perpetuated by the sequestration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix.
Retrospective review of a noncomparative case series, drawn from patients attending the lacrimal clinic at Moorfields Eye Hospital.
Characterization of this unrecognized syndrome and its response to treatment.
Twelve patients (10 female) presented between the ages of 77 and 93 years (mean, 85; median, 86) with a history of chronic relapsing bacterial conjunctivitis affecting, with 2 exceptions, just one eye. All had experienced multiple episodes of markedly purulent conjunctivitis and chronic ocular discharge for between 8 and 48 months (mean, 23.5; median, 24) before referral, and the patients had received multiple courses of treatment. Three had successful external dacryocystorhinostomy (for nasolacrimal duct occlusion) before the final diagnosis of giant fornix syndrome was made, 9 had developed corneal vascularization and scarring before referral, and 5 had suffered prior spontaneous corneal perforation or thinning. All patients had deep upper conjunctival fornices in association with the changes of age-related dehiscence of the levator muscle aponeurosis. Copious amounts of thick, purulent debris and a yellow coagulum were lodged in the depths of the upper fornix-this debris universally culturing Staphylococcus aureus. The condition settled rapidly on appropriate systemic antibiotics (ciprofloxacin or ofloxacin), intensive topical antibiotics, and high-dose, high-potency steroids; some patients required repeated treatment or needed to continue the use of a single drop of a combined steroid-antibiotic to prevent relapse.
The capacious upper fornix of the elderly may harbor a coagulum colonized by S. aureus, leading to chronic conjunctivitis that may lead to severe sight impairment due to toxic keratopathy and secondary corneal vascularization.
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ABSTRACT: To investigate the clinical and histopathological features of inflammatory lesions of the lateral canthal subconjunctival area. This is a retrospective case series of 12 patients with inflammatory subconjunctival masses in the lateral canthal area. All patients included in this study were treated at Seoul National University Hospital or Seoul National University Bundang Hospital between 2006 and 2012. Clinical data were obtained from the medical records. Histopathologic findings were thoroughly reviewed. There was a woman predominance in the study group (10:2), and the median age at presentation was 39 years (range 33-70). Common symptoms included conjunctival injection, sticky discharge, and pain or discomfort. Histopathologically, all lesions originated from ductules of the lacrimal gland. Two cases showed cysts containing clear fluid with mild inflammation. One case showed lacrimal ductulitis without cyst formation. Nine cases showed lacrimal ductal cysts with varying periductal inflammation, and the contents were pinkish, amorphous materials in 7 cases. Embedded cilia were found in 8 cases. Inflammatory lesions of the lateral canthal subconjunctival area all originated from lacrimal gland ductules, showing a variable histopathologic spectrum of inflammation and cyst formation. Cilia impaction was a very frequently observed finding.Ophthalmic plastic and reconstructive surgery 05/2014; 30(3):251-256. DOI:10.1097/IOP.0000000000000087 · 0.91 Impact Factor
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ABSTRACT: Many anophthlamic patients with ocular prostheses experience chronic discharge. A subset of these patients is found to have concurrent ptosis and an enlarged superior conjunctival fornix. Examination reveals an enlarged superior fornix with copious mucopurulent discharge. The subset of patients meeting these criteria is very small, and estimated incidence cannot be determined. The authors propose that using a modification of the conjunctivomullerectomy to decrease the potential space in the enlarged fornix while at the same time correcting the ptosis will help alleviate this chronic discharge. A retrospective review of 5 anophthalmic patients who underwent a modified superior conjunctivoplasty- mullerectomy was performed. All patients had chronic discharge and an enlarged superior conjunctival fornix, with mucous collection noted in the cul-de-sac. All patients had a concomitant ptosis and superior sulcus deformity on the affected side. Postoperative outcomes regarding correction of discharge, ptosis, and enlarged superior fornix were obtained. All patients had improvement in their chronic discharge. Palpebral fissure measurements improved from a median of 6.5 mm (range 6-8 mm) at baseline to 9.25 mm (range 8-10 mm) at last follow-up. The enlarged superior fornix was corrected in all patients. A modified superior conjunctivoplasty- mullerectomy is an effective method for correcting chronic discharge and ptosis in anophthalmic patients who have an enlarged superior conjunctival fornix.Ophthalmic plastic and reconstructive surgery 05/2010; 26(3):172-5. DOI:10.1097/IOP.0b013e3181b8c49a · 0.91 Impact Factor
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