Asymptomatic Follicular Conjunctivitis in an Elderly Man

Abstract

A 70-year old man with a history of soft contact lens wear presented for a general eye examination. Visual acuity was 20/20 OU with normal intraocular pressure. Several giant follicles were noted on the right inferior palpebral conjunctiva, and a few smaller follicles were noted in the left inferior fornix. Papillae were also noted bilaterally on the superior palpebral conjunctiva. He did not report any redness or discharge but did note mildly increased irritation mainly from soft contact lens wear. He had endorsed proper contact lens care and hygiene. He also noted an upper respiratory tract illness 4 weeks before presentation. Initially, he received a giant papillary conjunctivitis diagnosis because of soft contact lens intolerance and a recommendation to take a contact lens break. Because of the papillary reaction, prednisolone acetate, 1%, twice a day for 2 weeks was prescribed.After 3 months, the symptoms had improved in the left eye, but conjunctival follicles were still present in the right inferior palpebral conjunctiva (Figure 1). The patient subsequently underwent testing for chlamydia and gonorrhea, and the result was negative. At the 1-year follow-up, the examination findings were unchanged. During this follow-up, Lyme disease and Epstein-Barr virus serologic tests were performed in addition to repeated chlamydia testing. The results were negative, except for a positive Epstein-Barr virus IgG.