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JAMA Ophthalmology Clinical Challenge
November 14, 2019

Chronic Conjunctivitis in an Older Patient With Ptosis

Author Affiliations
  • 1Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
  • 2Division of Ophthalmology, NorthShore University HealthSystem, Chicago, Illinois
  • 3Department of Ophthalmology and Visual Science, The University of Chicago Pritzker College of Medicine, Chicago, Illinois
JAMA Ophthalmol. Published online November 14, 2019. doi:https://doi.org/10.1001/jamaophthalmol.2019.4439

A 76-year-old white woman with a history of left corneal stem-cell deficiency and cataract presented for a second opinion of recurrent left upper eyelid blepharedema, ptosis, erythema, photophobia, mucopurulent discharge, and a feeling she described as a “knife in my left eye” over the past 4 years (Figure 1). Previous treatment included topical steroids, antibiotics, and serum tears, with temporary relief. However, she experienced recurrences of symptoms after therapy discontinuation. Additional treatment included weekly bandage contact lenses for many months, which made the left eye pain tolerable. A dacryocystogram of the left lacrimal system indicated partial dacryostenosis, but compression of the canaliculi and lacrimal sac did not exacerbate discharge. A prior computed tomography scan of the orbits and sinuses showed no abnormalities. Her visual acuity was 20/30 OD and 20/100 OS. Deep superior conjunctival fornices were noted in both eyes (Figure 1), and eversion of the left upper eyelid revealed a pseudomembrane of the tarsal conjunctiva. Cultures of the copious discharge demonstrated many gram-negative Serratia marcescens. She subsequently started treatment with topical prednisolone acetate, moxifloxacin, and systemic azithromycin.

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