Abstract
Purpose: :
To describe the clinical and pathological characteristics of granulomatous conjunctival inflammation associated with primary chronic blepharitis in children
Methods: :
The clinical charts of 22 children (12 girls, 10 boys) aged from 1 to 13 years presenting with blepharitis and chronic conjunctivitis with suspected conjunctival granulomas were studied. Conjunctival biopsy and eyelids bacterial swabs were performed in 19 patients. Histological study of the epibulbar conjunctival biopsies was performed on all these specimens, and an additionnal immunohistochemistry analysis (CD3, CD4, CD8, CD1a, CD11c, CD68, CD123) was allowed on 8 cases. Accessory salivary glands biopsy was taken in 7 patients to eliminate association with sarcoidosis when clinical chart was doubtful.
Results: :
All children had a previous history of chalazia and all presented with blepharitis and meibomian gland dysfunction diagnosed as ocular rosacea. Conjunctival inflammation was micronodular in all cases, associated with follicules in 4 cases. Conjunctival granulomas clinically appeared as small whitish lesions or subtle yellowish nodules. Corneal complications were common (68.8%), including phlyctenular lesions (45.4%) and neovascularisation (68.8%). Eyelids bacterial samples were unproductive in most cases (73.3%). Epithelioid granulomas associated with giant cells infiltrated the conjunctival substantia propria in specimens of 15 patients (79%); inflammatory infiltrate without granuloma was found for 4 patients.Among those including granulomas, the specimens showed intra and peri-granulomas infiltration by inflammatory T-cells (CD3+), mainly T-helper/inducer (CD4+) cells, outnumbering the CD8+ cells, monocytic-derived cells (CD11c+) including macrophages (CD68+ CD1a+), and less frequently plasmacytoid dendritic cells (CD123+). The biopsy specimens of the accessory salivary glands were non-specific. patients were treated by topical steroids (95.4%), and some of them required topical ciclosporine (13.6%) or systemic erythromycin (36.3%). All children benefited from eyelids care and eye surface lubricants.
Conclusions: :
Granulomatous conjunctivitis seems to be an underrated complication of ocular rosacea in children. The immunopathological analysis of the conjunctiva identified the main cellular actors involved in the granulomatous inflammatory process. These results may provide a track start for a better understanding of ocular rosacea.
Keywords: conjunctiva • inflammation • pathobiology