Conjunctival Pocket Formation Following Adenoviral Conjunctivitis: A Rare Complication

To describe an unusual case of conjunctival fibrosis with conjunctival pocket formation after adenoviral conjunctivitis, leading to persistent foreign body sensation and corneal surface damage.

The optimal management of adenoviral pseudomembranous conjunctivitis is poorly defined and while debridement is commonly recommended, there is limited evidence base to support this practice. Peeling of membranes is recommended in pseudomembranous conjunctivitis but is controversial in membranous conjunctivitis.

A 60-year-old woman was referred to the anterior segment clinic due to persistent foreign body sensation in the right eye following adenoviral conjunctivitis. Visual acuity was 0.9, and intraocular pressure was within normal limits. Slit-lamp examination revealed superior linear corneal erosions without an identifiable foreign body. However, forced eversion of the upper eyelid revealed conjunctival fibrosis in the middle and inner thirds of the superior fornix, creating conjunctival pockets. Within these pockets, multiple trapped eyelashes were found, causing corneal abrasions. The eyelashes were removed, and therapeutic options were discussed, a conservative approach was chosen, consisting of artificial tears and gel at bedtime.

After several months of follow-up, the conjunctival fibrosis remained stable, and the patient remained asymptomatic.

This case highlights how adenoviral conjunctivitis, often considered a benign and self-limited condition, can lead to significant complications, particularly when associated with pseudomembranes that, if not removed promptly, may result in conjunctival fibrosis and ocular surface alterations. The formation of conjunctival pockets predisposing to eyelash entrapment is a rare complication with no well-established management guidelines. This case demonstrates that conservative treatment can be a valid first-line approach, reserving surgical intervention for more severe cases.