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Granular conjunctivitis: causes, symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 07.07.2025
Granular conjunctivitis includes the most common diseases such as follicular conjunctivitis, trachoma and folliculosis. All these diseases have a common, purely external similarity, expressed in the development of spherical follicular formations on the mucous membrane. In their origin, clinical manifestation, course and outcomes, they are completely different.
The follicle is not a specific element of trachoma, as was previously thought. The follicle can arise as a typical reaction of the adenoid tissue of the conjunctiva to a variety of effects. Under the influence of various agents, the lymphoid cells of the adenoid tissue are able to multiply, and where there were single cells, their clusters are formed - new follicles. The increase in lymphoid cells and follicles can be limited to the superficial layer of tissue or their reproduction occurs throughout the entire thickness of the adenoid layer. In this case, the looseness of the adenoid layer is lost, it is completely replaced by a cellular infiltrate of lymphoid cells, against which the number of follicles also increases.
[ Folliculosis
Folliculosis is a hyperplasia of the lymphoid elements of adenoid tissue, clinically expressed in the formation of follicles. Follicles appear on the unchanged healthy conjunctiva. They are located mainly on the lower transitional fold, sometimes on the upper one. The follicles are pale pink and are located superficially, sometimes in regular rows, like beads on a string. Folliculosis is observed mainly in children aged 8 to 15 years and is not a disease. This is an age-related condition of adenoid tissue. Simultaneously with folliculosis of the conjunctiva, similar follicles are found in children on the mucous membrane of the posterior pharyngeal wall and on enlarged tonsils. Children sleep with an open mouth, breathe poorly through the nose due to hypertrophy of the adenoids of the nasopharynx. Folliculosis does not cause subjective sensations and does not require treatment. Over time, hyperplasia of adenoid tissue disappears and the follicles disappear without a trace.
In adults, with increased sensitivity of the adenoid layer to external irritants (chemicals sprayed in the air and dust-like solid particles suspended in the air), follicles may also appear on the moribund or slightly hyperemic conjunctiva. For example, in some people, after instillation of atropine, small superficial follicles appear on the conjunctiva, which quickly disappear when the instillation of atropine is stopped. It is not difficult to distinguish folliculosis from trachoma. With folliculosis, as was said above, the follicles are pale pink and are located superficially on completely unchanged healthy conjunctiva along the lower transitional fold.
Follicular conjunctivitis
Follicular conjunctivitis is either infectious conjunctivitis, in which, in addition to the symptoms characteristic of it, follicles also appear, or it is infectious conjunctivitis that has developed against the background of the age-related condition of adenoid tissue - folliculosis.
In addition to follicles, the clinical picture includes infiltration and friability of the conjunctiva, discharge that glues the eyelids together overnight. This condition is sometimes mistaken for trachoma. Clinical observations show that follicular conjunctivitis, unlike trachoma, does not leave cicatricial changes in the conjunctiva and does not affect the cornea.
Histologically, follicles in folliculosis and trachoma may be the same, but the essence of the trachomatous process lies not only in the presence of follicles, but also in their cyclicity, in the changes that occur in the conjunctiva and cornea, in the diffuse cellular infiltrate of the adenoid layer in the follicles, which are subsequently replaced by connective tissue - a scar.
Trachoma
Trachoma is a specific, contact-transmitted chronic infectious, usually bilateral, inflammation of the conjunctiva of the eye, expressed by its diffuse infiltration with the formation of follicles (grains), their degeneration, decay and subsequent scarring.