Treatment of Conjunctival Concretions
Symptomatic conjunctival concretions should be mechanically removed at the slit lamp using a sterile needle or fine forceps under topical anesthesia, followed by topical antibiotic prophylaxis. 1
When to Treat vs. Observe
- Asymptomatic concretions require no treatment, as only 6% of patients with concretions experience symptoms. 2
- Mechanical removal is indicated when concretions cause corneal irritation, foreign body sensation, or epithelial defects from protruding deposits. 1
Removal Technique at the Slit Lamp
- Apply topical anesthesia (proparacaine 0.5%) before the procedure. 1
- Use a 25-30 gauge needle or jeweler's forceps to extract the calcified deposits from the palpebral conjunctiva. 1
- Evert the eyelid to visualize all concretions, as they typically occur on the superior or inferior tarsal conjunctiva. 1
- Common pitfall: Incomplete removal leads to recurrence—ensure thorough examination of all conjunctival surfaces with eversion. 1
Post-Procedure Management
- Apply topical antibiotic drops (moxifloxacin, tobramycin, or polymyxin B/trimethoprim) 3-4 times daily for 3-5 days to prevent secondary bacterial infection. 1
- Prescribe preservative-free artificial tears to address underlying dry eye disease that contributes to concretion formation. 1
- Consider brief topical corticosteroid use (loteprednol 0.5%) if significant conjunctival inflammation is present, with monitoring of intraocular pressure. 1
Follow-Up Protocol
- Schedule follow-up in 3-7 days to assess healing and ensure no residual concretions remain. 1
- Perform slit-lamp biomicroscopy to evaluate for corneal epithelial defects or persistent inflammation. 1
Addressing Underlying Causes to Prevent Recurrence
- Treat chronic blepharitis with lid hygiene and topical antibiotics if present, as this contributes to concretion formation. 1
- Discontinue offending topical medications, particularly preserved glaucoma drops, that cause chronic conjunctival inflammation. 1
- Optimize ocular surface health with aggressive lubrication using preservative-free artificial tears. 1
- Note: Dysfunction of Meibomian glands or chronic meibomitis is present in 30.3% of patients with conjunctival concretions and should be addressed. 2
When to Refer to Ophthalmology
Immediate ophthalmology referral is indicated for: 1
- 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