Treatment of Conjunctival Concretions
Symptomatic conjunctival concretions should be mechanically removed at the slit lamp using a sterile needle or fine forceps, followed by topical antibiotic prophylaxis to prevent secondary infection. 1
Clinical Approach to Management
Asymptomatic Concretions
- No treatment is necessary for asymptomatic conjunctival concretions, as they pose no threat to vision or ocular health 2, 3
- Observation alone is appropriate when patients have no foreign body sensation, irritation, or corneal involvement 2
Symptomatic Concretions Requiring Intervention
Mechanical removal is the definitive treatment when concretions cause:
- Foreign body sensation or ocular discomfort 2, 3
- Corneal irritation or epithelial defects from protruding concretions 1
- Chronic conjunctival inflammation 3
Removal Technique
- Perform removal at the slit lamp using topical anesthesia (e.g., proparacaine 0.5%) 4
- Use a 25-30 gauge needle or jeweler's forceps to extract the calcified deposits from the palpebral conjunctiva 5, 4
- Evert the eyelid to visualize all concretions, as they typically occur on the superior or inferior tarsal conjunctiva 5
- Apply topical antibiotic drops (such as moxifloxacin, tobramycin, or polymyxin B/trimethoprim) 3-4 times daily for 3-5 days post-procedure to prevent secondary bacterial infection 6, 4
Post-Procedure Management
Immediate Care
- Prescribe preservative-free artificial tears to address any underlying dry eye disease that may contribute to concretion formation 5, 3
- Consider brief topical corticosteroid use (e.g., loteprednol 0.5%) if significant conjunctival inflammation is present, with monitoring of intraocular pressure 5, 6
Follow-Up Strategy
- Schedule follow-up in 3-7 days to assess healing and ensure no residual concretions remain 1, 6
- Perform slit-lamp biomicroscopy to evaluate for corneal epithelial defects or persistent inflammation 5, 1
When to Refer to Ophthalmology
Immediate ophthalmology referral is indicated for: 1, 6
- Corneal involvement with epithelial defects or scarring
- Recurrent concretions despite appropriate treatment
- Associated conjunctival scarring or cicatricial changes
- Visual disturbance or moderate to severe pain
- Lack of response to initial removal and treatment
Common Pitfalls to Avoid
- Do not attempt removal without adequate visualization and anesthesia, as incomplete removal leads to recurrence 4
- Avoid aggressive manipulation that could cause conjunctival laceration or bleeding 4
- Rule out underlying chronic inflammatory conditions (such as chronic blepharitis or medication-induced conjunctivitis) that predispose to concretion formation 5
- Do not confuse concretions with other conjunctival lesions such as conjunctivochalasis, inclusion cysts, or foreign bodies, which require different management 2, 3, 4
Addressing Underlying Causes
- Treat chronic blepharitis with lid hygiene and topical antibiotics if present, as this contributes to concretion formation 6
- Discontinue any offending topical medications (particularly preserved glaucoma drops) that may cause chronic conjunctival inflammation 5
- Optimize ocular surface health with aggressive lubrication using preservative-free artificial tears 5, 3