12
Diagnosis
Table 4. Typical Clinical Signs of Conjunctivitis (cont'd)
Type of
Conjunctivitis Clinical Signs
Immune-mediated
OMMP • Bilateral. Bulbar conjunctival injection, papillary conjunctivitis,
conjunctival subepithelial fibrosis and keratinization, conjunctival
scarring beginning in the fornices, punctal stenosis and
keratinization, progressive conjunctival shrinkage, symblepharon,
entropion, trichiasis, corneal ulcers, neovascularization, and
scarring
GVHD • Bilateral. Conjunctival injection, chemosis, pseudomembranous
conjunctivitis, keratoconjunctivitis sicca, superior limbic
keratoconjunctivitis, cicatricial eyelid disease, episcleritis, corneal
epithelial sloughing, limbal stem cell failure, calcareous corneal
degeneration; rare intraocular involvement
Stevens-Johnson
syndrome
• Unilateral or bilateral. Bulbar conjunctival injection, conjunctival
subepithelial fibrosis and keratinization, conjunctival scarring,
punctal stenosis and keratinization, progressive conjunctival
shrinkage, symblepharon, entropion, trichiasis, corneal ulcers,
neovascularization, and scarring
Neoplastic
Sebaceous
carcinoma
• Unilateral. Intense bulbar conjunctival infection, conjunctival
scarring. May have a mucopurulent discharge. Corneal epithelial
invasion may occur
• Eyelids may exhibit a hard nodular, nonmobile mass of the
tarsal plate with yellowish discoloration; may appear as a
subconjunctival, multilobulated yellow mass, may resemble a
chalazion
Ocular surface
squamous neoplasia
• Conjunctival hyperemia, papillomatous or sessile nodules
Melanoma • Unilateral. Pigmented or nonpigmented lesion. Sentinel vessel.
Changing size or pigment to a lesion
NOTE: Typical clinical signs may not be present in all cases. Distinctive signs are most useful in
making a clinical diagnosis but may occur uncommonly. In all entities, laterality may vary and may be
asymmetrical.
