Conjunctival concretions are small vascular, granular, yellowish-white deposits being produced due to conjunctival degeneration and are found in the sub-tissues of the eyelid conjunctiva and fornix (junction between palpebral and bulbar conjunctiva) in the elderly group or in younger patients with chronic inflammatory conditions. Deposits have been found in patients as young as 20 years old, with the range of occurrence from 30-80 years old. Concretions appear as multiple tiny cysts containing yellowish-white deposits of compacted mucous and degenerated epithelial debris including keratin. They are frequently tiny, but larger concretions are not uncommon. In one study, no significant difference was found between the localization on the upper and lower eyelids, right or left eye, and most of the concretions were superficial and hard, and mainly single. Associated dysfunction of meibomian/oil glands was also noticed in some patients. Typically, patients with conjunctival concretions are affected with dry eye disease.
Concretions are almost always asymptomatic because they usually remain hidden into the eyelid conjunctiva, and not noticed by patients until they become large and protrude through the eyelid tissues. Concretions may irritate eyes, but only if they erode the overlying tissues and come in contact with the cornea. Protruding concretions may cause symptoms such as:
- Foreign body sensation.
- Lacrimation (watering).
- Corneal abrasion (less common).
Concretions are formed due to the accumulation of epithelial cells, calcium, and impacted mucous in depressions called Henle glands. The causes and risk factors for conjunctival concretions are variable but are associated most commonly with:
- Aging process.
- Chronic conjunctival inflammation.
- Tear film deficiency (dry eyes).
- Severe allergic conjunctivitis.
- Meibomian (oil) gland dysfunction (e. g. chronic meibomianitis).
- Re-crystallization of certain eye drops (e.g. sulphadiazine).
Diagnosis of conjunctival concretions is often incidental. Patients are usually asymptomatic and conjunctival concretions are noted on ocular examination. Some patients with protruding concretions may complain of irritation and foreign body sensation in eye. Patients may or may not give history of chronic conjunctivitis.
Conjunctival concretions are small 1- 2 mm, yellow-white lesions typically present on eyelid conjunctiva. Concretions may be single, multiple, or confluent rarely.
Components of concretions
The primary components of conjunctival concretions are degenerating epithelial cells and compacted secretions from conjunctival glands. Following inflammation, the debris get trapped in sub-conjunctival depressions (Henle glands), and they often undergo calcification. Conjunctival concretions are finely granular and membranous debris.
Non-symptomatic conjunctival concretions: Since concretions are located in sub-epithelial space and are asymptomatic, management is usually unnecessary and is not required.
Symptomatic conjunctival concretions: If concretions erode through the epithelium and produce symptoms, they can often be removed with a small-gauge needle under topical surface anesthesia at the slit lamp (bio-microscope), by an eye specialist.