7
Table 3. Natural History of Conjunctivitis (cont'd)
Type of
Conjunctivitis Natural History Potential Sequelae
Immune-mediated (cont'd)
GVHD Can involve multiple
tissues including skin, liver,
gastrointestinal system, lung,
and eye. Gra-versus-host
disease may follow acutely
within the first 3 months
following hematopoietic stem
cell transplantation, but ocular
disease is more common in the
chronic phase
• Conjunctivitis;
subconjunctival fibrosis;
symblepharon; lacrimal
gland involvement;
keratoconjunctivitis sicca;
cicatricial lid disease
• Less commonly limbal
stem cell deficiency, corneal
scarring, or intraocular
involvement
Stevens-Johnson
syndrome
Involves the various mucous
membranes including the
gastrointestinal system, lung
and eye following the systemic
use of sensitizing medication
Conjunctival scarring and
shrinkage; symblepharon;
trichiasis; corneal scarring,
neovascularization, ulceration;
limbal stem cell deficiency;
ocular surface keratinization;
bacterial conjunctivitis;
cicatricial lid changes; severe
tear deficiency; severe vision loss
Neoplastic
Sebaceous carcinoma Occurs in 5th–9th decades of
life with fairly rapid progression
Orbital invasion, regional or
distant metastases, melanoma
Ocular surface
squamous neoplasia
May be history of HPV,
significant UV exposure,
chronic inflammation; may be
mistreated as an unresponsive
blepharoconjunctivitis
Conjunctival hyperemia,
carcinoma in situ, or ocular
surface squamous neoplasia,
which can be locally invasive
with regional metastases
Melanoma Significant UV exposure,
previous history of melanoma,
previous PAM or nevus of Ota
Pigmented, or non-pigmented
lesion, invasive regional
metastases, history of previous
melanoma, primary may not be
conjunctival
