UNILATERAL CHRONIC BLEPHARO-KERATO-CONJUNCTIVITIS UNRESPONSIVE TO TREATMENT AS A LEAD SYMPTOM OF AUTOAGGRESSIVE SYNDROMES: CLINICAL AND HISTOPATHOLOGICAL FINDINGS
A. Assadoullina, A.A. Bialasiewicz, A. Hassenstein, G. Richard
The differential diagnostics of chronic unilateral blepharo-kerato-conjunctivitis includes allergic, infectious, rosacea, OCP and tumor-associated inflammations. We report on 4 patients with recurrent infections and delayed-type hypersensitivity reactions due to autoaggressive manipulations.
Patients: Three female (age: 21, 25, 45 yrs.) and one male patient (age: 41 yr.) suffered from a strictly right (3x) of left-handed (1x) therapy-resistant blepharo-kerato-conjunctivitis, which had persisted since 2 months, one, 2 and 3 yrs. Professional activities: nurses 2x, medical assistants 1x, college student 1x. In each case more than 5 ophthalmologists and 2-6 large eye centers had been consulted, and extraocular sugery had been performed 1-6x during the symptomatic time period.
Results: V.A.: 2x 0.2, 1x 0.1, 1x FC. Morphology: dermal contact eczema an inflammatory corneal pannus 2x, purulent pseudomembraneous (2x), an cicatricial conjunctivitis (2x). Bacteriology: P.aeruginosa, S.epidermidis, S.aureus, S.pneumoniae. Histopathology: conjunctiva: chronic-inflammation (3x), acute purulent (2x) subepithelial and stromal infiltrates with hyper- and parakeratosis (2x) or epithelial denudation (1x) and stromal scarring; lids: parakeratosis, focal necrosis, intercellular edema, lyphohistiocytic infiltrates.Additional lesions: multiple allergies vs.antibiotics and preservatives (4x), self-inflicted injuries of the extremities (1x) irritative-toxic dermatitis (1x). Psychiatry: dependent-infantile personality deviation, somatized-agitated personality; two patients declined an evaluation.
Conclusions: Autoaggression syndromes should be considered, if chronic unilateral blepharo-kerato-conjunctivitis and appropriate handyness, exacerbations directly before examinations, a history of multiple hospitalizations, diagnostic procedures and surgery in paramedics occur.
Supported by Deutscher Akademischer Austauschdienst A/96/28745
University Eye Hospital Eppendorf, Martinistr. 52, D-20246 Hamburg