From the Guidelines
Tarsal conjunctivitis is an inflammatory condition affecting the tarsal conjunctiva, characterized by inflammation, redness, and the formation of small bumps called papillae on the underside of the eyelids, commonly occurring as a reaction to allergens, contact lens wear, or as part of more extensive allergic eye diseases. This condition is also known as meibomian conjunctivitis, and it is essential to differentiate it from other types of conjunctivitis, such as rosacea conjunctivitis, contact lens–related keratoconjunctivitis, or giant papillary conjunctivitis (GPC) 1. The symptoms of tarsal conjunctivitis typically include eye redness, itching, tearing, mucous discharge, and a gritty sensation.
Causes and Risk Factors
The causes of tarsal conjunctivitis can be diverse, including:
- Allergens
- Contact lens wear
- Mechanical irritation
- Systemic conditions such as atopy or acute infections
- Ocular diseases like dry eye or blepharitis 1.
Treatment and Management
Treatment depends on the underlying cause but often includes:
- Artificial tears for lubrication
- Antihistamine eye drops like ketotifen or olopatadine for allergic cases
- Topical steroids like fluorometholone 0.1% for more severe inflammation
- Cold compresses for symptomatic relief
- Changing lens type, reducing wearing time, or improving lens cleaning regimens if contact lens wear is the cause 1.
Pathophysiology
The condition develops because allergens or mechanical irritation trigger mast cell degranulation and release of inflammatory mediators in the conjunctival tissue, leading to the characteristic papillary reaction on the tarsal surface. It is crucial to address the underlying cause of the condition to prevent complications such as tarsal scarring, ptosis, or corneal abrasion/erosions 1.
Key Considerations
In clinical practice, it is essential to consider the potential sequelae of tarsal conjunctivitis, such as evaporative dry eye, corneal neovascularization, or stromal scarring, and to manage the condition accordingly to prevent these complications 1.
From the Research
Definition and Causes of Tarsal (Meibomian) Conjunctivitis
- Tarsal conjunctivitis is a form of conjunctivitis that affects the tarsal conjunctiva, which is the membrane covering the inside of the eyelids 2.
- It can be caused by various factors, including allergic reactions, toxic substances, and infections 2, 3.
- The condition is characterized by inflammation of the tarsal conjunctiva, which can lead to symptoms such as epiphora, stickiness, and mild bulbar conjunctival hyperaemia 2.
Clinical Features and Diagnosis
- The clinical features of tarsal conjunctivitis include bilateral moderate to severe upper and lower tarsal conjunctival papillary reaction, without corneal or eyelid changes 2.
- Diagnosis is based on clinical history, eye evaluation, and laboratory tests such as allergological tests and conjunctival scraping 4, 3.
- Histological examination of biopsies can also help confirm the diagnosis, showing a variable superficial stromal lymphocytic infiltrate and follicle formation 2.
Treatment and Management
- Treatment of tarsal conjunctivitis depends on the underlying cause and severity of symptoms 4, 3.
- Topical steroid drops can provide relief from symptoms, but withdrawal of the inciting agent is necessary to resolve the condition 2.
- Avoidance of potential contact allergens is also crucial in managing the condition 2.
- In severe cases, novel steroid-sparing therapies such as Cyclosporine A eye drops or topical Tacrolimus may be used 4.