What is Conjunctival Concretions?
A conjunctival concretion is a harmless condition that appears as one or more small yellowish-white spots. These spots can vary in size and are most frequently seen in older people. Often, they don’t have a known cause, but they can also occur as a result of chronic inflammation of the eye surface, such as in the condition trachoma. These concretions most often exist under the skin of the inner eyelid or the folds of the eye. They are typically symptomless when small, but when they grow larger, they can cause discomfort or other symptoms.
What Causes Conjunctival Concretions?
Concretions, or small hardened lumps, usually occur naturally due to changes in the tissue that lines the inside of the eyelids as we age.
Other reasons for concretions can include:
- An allergic or long-term infection that affects the surface of the eye such as trachoma, allergic keratoconjunctivitis, and atopic keratoconjunctivitis.
- Dry eye disease associated with mild inflammation: for example, chronic meibomitis or dry eye.
- A side effect from certain eye drops, one known instance is sulphadiazine.
Risk Factors and Frequency for Conjunctival Concretions
Conjunctival concretions, which are an eye condition, can affect anyone regardless of their gender. They are commonly found in older individuals, but they can also appear in younger people, especially those in their 20s and 30s. This is particularly true if these younger individuals have had prolonged inflammation. Studies have found these concretions in about 40 to 50% of the people they looked at. Additionally, research shows that it doesn’t favor one eye over the other, or the top or bottom part of the inside of the eyelid.
Signs and Symptoms of Conjunctival Concretions
Generally, an individual with concretions in their eye doesn’t show any symptoms. These concretions are often discovered by chance during an eye exam for some other reason. However, when these concretions become large, they can cause symptoms. These may include:
- Irritation
- A feeling like there’s something in the eye, often at a specific spot
- Tearing
- Redness
- Sensitivity to light (usually when large concretions on the upper inside of the eyelid rub against the cornea)
- Blurred vision
Testing for Conjunctival Concretions
A diagnosis can be made by a doctor examining your eyelids while turning them outwards and using a specialized microscope. These health problems, known as concretions, can occur alone or in multiples. They appear as yellowish-white spots found in the fold or the covering of the eyes. Sometimes, these can merge together. Larger ones or those merged, might push through the eye covering and stick out, causing noticeable symptoms. Around their area, the eye’s covering might show signs similar to an allergic reaction, such as small bumps and redness.
Treatment Options for Conjunctival Concretions
If a person has small, hard deposits or stones (known as concretions) but isn’t experiencing any symptoms, and these stones are discovered by chance, doctors usually choose not to perform any operations or procedures. This is because most people with these concretions don’t experience any symptoms and don’t need specific treatment.
However, if a person is experiencing symptoms, doctors might decide to remove the specific concretions causing the problems.
Here’s how the removal process usually goes:
First, doctors administer an eye drop containing a local anesthetic (Proparacaine hydrochloride 0.5%), which numbs the eye. The eyelid is then turned inside out to expose the inner surface of the eyelid. To achieve better numbness, a cotton swab soaked with the anesthetic might be used directly on the concretion.
To remove the concretion, doctors may use either a small needle (26G or 30G) or fine-tipped forceps. If using a needle, it is positioned with the flat side away from the eyelid and gently pushed under one end of the concretion to lift and remove it from the inner surface of the eyelid.
It’s common to see a little bit of blood during removal, but it can easily be controlled by applying pressure to the area. After the removal, an antibiotic eye drop or ointment is put into the eye. If the corneal surface (the clear, front surface of the eye) gets damaged during removal, antibiotic drops or ointment might be needed for a few days afterwards.
What else can Conjunctival Concretions be?
The diagnosis of conjunctival concretion, a condition where calcium deposits form in the eye, may look similar to other issues. It’s important to differentiate it from the following conditions:
- Conjunctival foreign body: This happens when a small object gets stuck in the tissue that lines the inside of your eyelids and covers the white part of your eye. If it’s partially buried in this tissue, it might look like a concretion.
- Epidermal inclusion cyst: These cyst-like formations can be present at birth or develop later. They are filled with clear fluid and are found just beneath the skin’s surface. However, unlike concretions, which are solid and filled with a protein called keratin, these cysts are not solid.
- Lymphoid follicle: These are also found just below the surface, but they are usually more spread out and occur in multiple numbers. When looked at under a microscope, they show immature cells in the center, surrounded by mature cells.
It’s also rare but possible to confuse this condition with ophthalmia nodosa. This is an inflammatory response in the eye to foreign bodies like hair or caterpillar spines. This condition can lead to multiple tiny scratches on the cornea. But, unlike with concretions, these eyes show more inflammation and a tissue reaction around the foreign body.
Ophthalmia nodosa has had various names throughout history. It was once called “nursemaid’s disease” in the early 20th Century because many caregivers who sat with children under trees in Hyde Park were often affected by skin hives and pink eye caused by hairs from a specific type of moth.
What to expect with Conjunctival Concretions
Conjunctival concretions, which are harmless, can be cured completely if they cause symptoms and are treated. However, if they are linked with inflammation or an allergy, it’s important to treat these conditions properly to prevent the concretions from coming back. It’s generally recommended not to remove concretions that don’t cause any symptoms.
Possible Complications When Diagnosed with Conjunctival Concretions
Conjunctival concretions, a condition affecting the eyes, are rarely linked to further problems. However, they can cause a scratch on the surface of the eye, known as a corneal abrasion. This could result in discomfort, pain, light sensitivity, eye redness, blurred vision, corneal ulceration, or dry eye.
Possible Symptoms:
- Discomfort or pain
- Sensitivity to light
- Redness of the eye
- Blurred vision
- Corneal ulceration
- Dry eye
Preventing Conjunctival Concretions
Concretions, or small hard lumps in the eye, are often discovered by accident during a regular eye checkup using a special microscope. If you’re diagnosed with concretions, your doctor will assure you that it’s not a dangerous condition. If you don’t have any symptoms, your doctor may just keep an eye on it.
However, if you do have symptoms like a feeling that something is in your eye, irritation, redness, or watery eyes, these lumps might need to be removed. This procedure is done using a local numbing eye drop in an outpatient clinic, meaning you don’t need to stay overnight in the hospital. Recovery from this procedure is usually quick and doesn’t cause much discomfort.
Do keep in mind that concretions can come back, especially if your eyes become inflamed for some reason.
