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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
To J, Macsai M, Phelps PO. Chronic Conjunctivitis in an Older Patient With Ptosis. JAMA Ophthalmol. 2020;138(1):97–98. doi:10.1001/jamaophthalmol.2019.4439
Monkeypox Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.