Concretions

Aetiology

Conjunctival epithelial inclusion cysts containing epithelial debris with mucinous secretions, sometimes with a hard texture

Predisposing factors

Common, especially over the age of 50 years (prevalence in ophthalmology outpatient population has been reported as approximately 40%)

Chronic conjunctivitis (any cause, including contact lens wear)

Accumulation of lipid under conjunctiva, e.g. concretions grouped around an old chalazion

Symptoms of concretions

Usually none

May erode through the epithelium, causing

  • foreign body sensation
  • epiphora
  • redness

Signs of concretions

Small white/yellow-white bodies with distinct edges in tarsal (upper or lower) conjunctiva

Single or multiple

May stain with fluorescein

Usually <1mm diam, sometimes up to 3mm 

  • appear larger if confluent

Usually low profile but may be raised if large

Differential diagnosis

Conjunctival retention cysts

  • thin walled cysts containing clear or translucent fluid

Follicles

  • focal lymphoid hyperplasia

Management by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above

Non pharmacological

Treatment rarely required
Artificial tears and lubricating ointments (drops for use during the day, unmedicated ointment for use at bedtime)
(GRADE*: Level of evidence = low, Strength of recommendation = strong)

NB Patients on long-term medication may develop sensitivity reactions which may be to active ingredients or to preservative systems (see Clinical Management Guideline on Conjunctivitis Medicamentosa). They should be switched to unpreserved preparations

Eroded concretions leading to irritation can be removed at the slit lamp

  • topical anaesthetic
  • tease out with sterile hypodermic needle, keeping needle tangential to eye surface to minimise risk of accidental injury
  • any bleeding should respond quickly to finger pressure on the lid - (N.B. check first that patient has no bleeding disorder and is not taking aspirin or anti-coagulants)
  • consider topical antibiotic as prophylactic if infection seems likely (e.g. gutt. or oc. chloramphenicol)

(GRADE*: Level of evidence = low, Strength of recommendation = weak)
 

Pharmacological

No specific drug treatment available
Topical anaesthetic and antibiotic for minor surgery as above
(GRADE*: Level of evidence = low, Strength of recommendation = weak)
 

Management category

B3: management to resolution

Possible management by ophthalmologist

Not normally required

Concretions if multiple can be removed under local anaesthesia using a small chalazion curette

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation  (www.gradingworkinggroup.org)
 

Sources of evidence

Haicl P, Jankov√° H. Prevalence of conjunctival concretions. Cesk Slov Oftalmol. 2005;61(4):260-4 [Article in Czech]

Kulshrestha MK, Thaller VT. Prevalence of conjunctival concretions. Eye (Lond). 1995;9(6):797-8

Lam D, Wong EL, Agar A, Coroneo MT, Francis IC. Curettage for copious conjunctival concretions. Cureus. 2020;12(11):e11742

Plain language summary

Concretions are small white or yellowish dots, usually less than 1mm in diameter, commonly seen on the undersides of the eyelids. They contain cell debris and mucus. They may be the result of past inflammation. Occasionally they cause irritation or the feeling that there is something in the eye.

If concretions are causing symptoms, the optometrist may offer to remove them. After numbing the eye surface with an anaesthetic drop, the concretions can usually be teased out with the tip of a hypodermic needle. Rarely, antibiotic drops may be prescribed.

Such cases do not usually need to be referred to the ophthalmologist. However, if the concretions are present in large numbers and are causing discomfort, the patient may be referred for consideration of minor surgery under local anaesthetic.

Concretions Version 7
Date of search 17.11.21
Date of revision 05.09.22
Date of publication 14.09.22
Date for review 16.11.23
© College of Optometrists

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