Giant Fornix Syndrome: A Case Series

Abstract

 

Purpose:

 

Giant fornix syndrome is a rare cause of chronic purulent conjunctivitis in the elderly. The deep conjunctival fornices can be a site for prolonged sequestration of bacteria causing recurrent infections.

 

Methods:

 

Retrospective chart review of five patients with giant fornix syndrome evaluated by the Cornea Service, Oculoplastics & Orbital Surgery Service and the Department of Pathology at the Wills Eye Institute.

 

Results:

 

The median age of the five female patients was 75 years (mean 80, range 70-95). The median duration of eye symptoms before presentation was 2 years (mean 2.4, range 1-4). Prior to referral, the chronic conjunctivitis was treated with topical antibiotics in all 5 cases and with additional dacryocystorhinostomy (DCR) in one case. The right eye was affected in 2 cases and the left eye in the other 3. Floppy eyelids were present in 2 cases. The superior fornix was involved in 4 cases and the inferior fornix in one case. Pseudomembranes and superficial punctate keratitis (SPK) were seen in 3 cases. Diagnosis of giant fornix syndrome was made in all 5 cases. Conjunctival culture grew methicillin resistant Staphylococcus aureus (MRSA), Pseudomonas aerugenosa and Staphylococcus aureus in singular cases. Case 1 was treated with topical moxifloxacin, case 2 with topical vancomycin and repair of the upper eyelid, case 3 with topical besifloxacin and case 4 with DCR and topical vancomycin. Case 5 was treated with reconstruction of the left upper eyelid. The median duration of follow-up was 4 months (mean 21.6, range 1-84).

 

Conclusions:

 

Giant fornix syndrome can lead to chronic relapsing conjunctivitis in elderly. Removing the infected debris from the superior fornix and reconstruction of the upper eyelid may prevent the chronic persistent infection.  

 

Keywords: conjunctiva • eyelid • microscopy: light/fluorescence/immunohistochemistry