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Follicular conjunctivitis - External and Internal Eye
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Follicular conjunctivitis - External and Internal Eye

Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed


Most forms of follicular conjunctivitis are a local host response to an exogenous substance or agent producing prominent subconjunctival lymphoid follicles. Viruses, chlamydia, and bacteria can produce the problem. Careful history, clinical examination, and simple lab tests are required to ferret out specific causes. Symptoms and signs depend on the causative agent but may include watery discharge, conjunctival hyperemia, sandy/gravely feeling, blurry vision, and photophobia. There are both acute and chronic forms of follicular conjunctivitis with the latter defined as those cases of follicular conjunctivitis that persist for more than 16 days. In the acute form, presentation is often unilateral followed within a week by involvement of the second eye. Frequently in the acute form, preauricular lymphadenopathy on the affected side is present.

Note that conjunctival follicles do not occur in neonates, yet they are susceptible to many of the same diseases that cause them in adults.


H10.019 – Acute follicular conjunctivitis, unspecified eye
H10.439 – Chronic follicular conjunctivitis, unspecified eye

86402005 – Follicular conjunctivitis

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Differential Diagnosis & Pitfalls

Causes for the acute form of follicular conjunctivitis include:
  • Pharyngoconjunctival fever
  • Epidemic keratoconjunctivitis
  • Herpes simplex virus conjunctivitis
  • Herpes simplex virus blepharitis
  • Newcastle disease
  • Viral conjunctivitis
  • Inclusion conjunctivitis
  • Other zoonoses
  • Acute hemorrhagic conjunctivitis
  • Rubella
Causes for the chronic form of follicular conjunctivitis include:
  • Trachoma, Inclusion conjunctivitis, and other chlamydial infections
  • Toxic follicular conjunctivitis
  • Molluscum contagiosum
  • Drug-induced conjunctivitis
  • Ocular cosmetics
  • Bacteria (Moraxella lacunata and others)
  • Chronic follicular keratoconjunctivitis of Thygeson
  • Oculoglandular syndrome of Parinaud (eg, from Cat-scratch disease or Tularemia)
  • Rosacea blepharoconjunctivitis
  • Lyme keratitis
Because the causes for follicular conjunctivitis cross so many disease entities, it is imperative to obtain an excellent history, do a careful physical exam, and employ appropriate lab testing.

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:07/31/2014
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Patient Information for Follicular conjunctivitis - External and Internal Eye
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Follicular conjunctivitis - External and Internal Eye
A medical illustration showing key findings of Follicular conjunctivitis (Acute) : Blurred vision, Photophobia, Gritty eyes, Palpebral conjunctival injection, Preauricular lymphadenopathy, Unilateral distribution, Conjunctival injection, Eye discharge
Clinical image of Follicular conjunctivitis - imageId=2897559. Click to open in gallery.  caption: 'Gray-white lymphoid follicles and surrounding dilated blood vessels on the tarsal conjunctiva, secondary to <i>Chlamydia</i> infection.'
Gray-white lymphoid follicles and surrounding dilated blood vessels on the tarsal conjunctiva, secondary to Chlamydia infection.
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