=Follicular conjunctivitis= is of catarrhal origin. It is characterized
by the presence of follicles. There may be only a few or a great many.
If numerous they are often in rows on the palpebral conjunctiva.
Microscopically they show as circumscribed masses of adenoid tissue. In
this they resemble the granules of =trachoma=. Sometimes cases persist
for years with little or no inflammatory symptoms. On account of the
follicles this disease is frequently confused with trachoma.
We have heard numbers of well meaning conscientious osteopathic
physicians testify to curing cases of trachoma with a short course of
osteopathic treatment with no pathology remaining. We are absolute
believers in the effectiveness of osteopathic treatment and want
to give it full credit for doing all it will; but here we want to
enter a plea to the profession that we need more discrimination and
definiteness in our diagnosis. Technique is being emphasized and we say
Amen! It is proper for us to be thoroughly competent in technique but
diagnosis should be made just as emphatic because scientific technique
depends upon diagnosis for each individual case.
=Differentiation= of follicular conjunctivitis from trachoma.
=Follicular conjunctivitis= occurs (1) chiefly in the young; (2) the
follicles are smaller, more sharply limited, project more above the
conjunctiva, are often in rows, and oval in shape; (3) the disease
clears up with no bad after effects often without any treatment and the
tendency is to ultimately get well; (4) it never leads to shrinking of
the conjunctiva, to pannus or other destructive sequelæ; (5) it can
arise without contagion and is not considered contagious although, like
trachoma, it does attack large numbers of people who are confined in a
small place.
=Trachoma.=—(1) It seldom occurs in children; (2) the follicles are
larger, do not have sharp outlines, are less prominent under the
conjunctiva, are round in shape and never in rows; (3) tends to lead
to more or less pathology and seldom recovers spontaneously; (4) scar
tissue becomes a product of the inflammation in the conjunctiva and
leads to shrinking of the conjunctiva, causing in turn entropion and
trichiasis. Pannus is the sure result of unarrested cases as there is
a tendency to infection of the cornea from the infected conjunctiva
moving over it and remaining in contact; (5) trachoma has been proved
to be contagious. Trachoma bodies which are considered the infective
agent have been isolated.
The use of atropine in some instances will cause a follicular catarrh
which clears up on stopping the use of the poison.
Parinauds “Infectious conjunctivitis” has granulations but almost
always occurs in only one eye and is accompanied with constitutional
symptoms.
=Treatment of Follicular Conjunctivitis.=—The treatment should be
directed against the inflammation. The trophicity of the nerve
terminals to the conjunctiva may be altered by osteopathic lesions.
Suggestions under chronic catarrhal conjunctivitis apply here. If there
is no inflammation the follicles tend to disappear, leaving no trace
of pathology, hence a few osteopathic treatments of the lids and the
cervical region will hasten normalization.