Aim To describe a group of elderly patients presenting with chronic,relapsing,copiously puru lent conjunctivitis,inwhich the condition was often perpetuated by the seques-tration of a large number of bacteria on a pro...Aim To describe a group of elderly patients presenting with chronic,relapsing,copiously puru lent conjunctivitis,inwhich the condition was often perpetuated by the seques-tration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix.Patients and methods Retrospective review of a noncom-parative case series,drawn from patients attending the lacrimal clinic at Moorfields Eye Ho spital.Outcome mea-sures Characterization of this unre cognized syndrome and its response to treatment.Results T welve patients(10fe-male)presented between the ages of 77and 93years(mean,85;median,86)with a history of chronic re-lapsing bacterial conjunctivitis a ffecting,with 2excep-tions,just one eye.All had experien ced multiple episodes of markedly purulent conjunctivitis and chronic ocular discharge for between 8and 48months(mean,23.5;median,24)before referral,and the patients had received multiple courses of treatment.Thre e had successful ex-ternal dacryocystorhinostomy (for nasolacrimal duct oc-clusion)before the final diagnosis of giant f ornix syndrome was made,9had developed corneal vascularization and scarring before referral,and 5had s uffered prior sponta-neous corneal perforation or thinni ng.All patients had deep upper conjunctival fornices in association with the changes of agerelated dehiscence of the levator muscle aponeurosis.Copious amounts of thi ck,purulent debris and a yellow coagulum were lodged in t he depths of the upper fornix-this debris universally culturing Staphylococ-cus aureus.The condition settled ra pidly on appropriate systemic antibiotics(ciprofloxacin or ofloxacin),intensive topical antibiotics,and high-dose,highpotency steroids;some patients required repeated tre atment or needed to continue the use of a single drop of a c ombined steroid-antibiotic to prevent rela pse.Conclusion The ca-pacious upper fornix of the elderly may harbor a coagulum colonized by S.aureus,leading to ch ronic conjunctivitis that may lead to severe sight impairm ent due to toxic ker-atopathy and secondary corneal vasc ularization.展开更多
文摘Aim To describe a group of elderly patients presenting with chronic,relapsing,copiously puru lent conjunctivitis,inwhich the condition was often perpetuated by the seques-tration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix.Patients and methods Retrospective review of a noncom-parative case series,drawn from patients attending the lacrimal clinic at Moorfields Eye Ho spital.Outcome mea-sures Characterization of this unre cognized syndrome and its response to treatment.Results T welve patients(10fe-male)presented between the ages of 77and 93years(mean,85;median,86)with a history of chronic re-lapsing bacterial conjunctivitis a ffecting,with 2excep-tions,just one eye.All had experien ced multiple episodes of markedly purulent conjunctivitis and chronic ocular discharge for between 8and 48months(mean,23.5;median,24)before referral,and the patients had received multiple courses of treatment.Thre e had successful ex-ternal dacryocystorhinostomy (for nasolacrimal duct oc-clusion)before the final diagnosis of giant f ornix syndrome was made,9had developed corneal vascularization and scarring before referral,and 5had s uffered prior sponta-neous corneal perforation or thinni ng.All patients had deep upper conjunctival fornices in association with the changes of agerelated dehiscence of the levator muscle aponeurosis.Copious amounts of thi ck,purulent debris and a yellow coagulum were lodged in t he depths of the upper fornix-this debris universally culturing Staphylococ-cus aureus.The condition settled ra pidly on appropriate systemic antibiotics(ciprofloxacin or ofloxacin),intensive topical antibiotics,and high-dose,highpotency steroids;some patients required repeated tre atment or needed to continue the use of a single drop of a c ombined steroid-antibiotic to prevent rela pse.Conclusion The ca-pacious upper fornix of the elderly may harbor a coagulum colonized by S.aureus,leading to ch ronic conjunctivitis that may lead to severe sight impairm ent due to toxic ker-atopathy and secondary corneal vasc ularization.
