4
Etiology
Table 3. Natural History of Conjunctivitis
Type of
Conjunctivitis Natural History Potential Sequelae
Allergic
Seasonal Recurrent Minimal, local
Vernal Onset in childhood; chronic
course with acute exacerbations
during spring and summer.
Gradual decrease in activity
within 2–30 years
Eyelid thickening ; ptosis;
conjunctival scarring ; corneal
neovascularization, thinning,
ulceration, infection; visual
loss; keratoconus
Atopic Onset in childhood; chronic
course with acute exacerbations
Eyelid thickening or tightening,
loss of lashes; conjunctival
scarring ; corneal scarring,
neovascularization, thinning,
keratoconus, infection,
ulceration; cataract; visual loss
GPC Chronic gradual increase in
symptoms and signs with
contact lens wear, exposed
corneal or scleral sutures, ocular
prosthesis
Ptosis
Mechanical/Irritative/Toxic
SLK Subacute onset of symptoms,
usually bilateral. May wax and
wane for years
Superior conjunctival
keratinization, pannus,
filamentary keratitis
Contact-lens-related
keratoconjunctivitis
Subacute to acute onset of
symptoms. May take months or
longer to resolve with treatment
and withdrawal of contact
lenses
Superior epitheliopathy and
corneal scarring ; limbal stem
cell deficiency; may progress
centrally into the pupillary area
Floppy eyelid
syndrome
Chronic ocular irritation
due to nocturnal eyelid
ectropion causing upper-tarsal
conjunctiva to come in contact
with bedding
Punctate epithelial keratitis;
corneal neovascularization,
ulceration, and scarring ;
keratoconus
Giant fornix
syndrome
Chronic mucopurulent
conjunctivitis, which waxes
and wanes with typical short
courses of topical antibiotic
therapy
Elderly women, ptosis,
superior hyperemia, chronic
conjunctivitis, large superior
fornix with coagulum of
mucopurulent material
Pediculosis
palpebrarum
(Phthirus pubis)
Blepharitis and conjunctivitis
persist until treated
Chronic blepharitis,
conjunctivitis, and, rarely,
marginal keratitis
