Therapy-resistant unilateral chronic blepharokeratoconjunctivitis as the main finding in autoaggression syndrome. Clinicohistopathological findings

Autoaggressive syndromes as causes of diseases underlying chronic blepharit is and keratoconjunctivitis that are refractory to treatment are often diff icult to recognize. Patients: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4 x) or left -(1 x) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2,11 and 30 months prior to admission. In each case more than 5 ophthalmologist s and 2-6 eye hospitals had been consulted, and extraocular surgery had bee n performed 1-4 times. Results: Patients presented with a visual acuity of 0.3 p (1 x), 0.1 (1 x), FC (1 x), HM (1 x). In three patients contact eczem a of the facial skin and lids and a corneal pannus were observed; in two pa tients we saw purulent pseudomembranous and in two patients chronic cicatri zing keratoconjunctivitis. Conjunctival smears grew Fl aeruginosa, and 5. a ureus; impression cytology showed infiltration with neutrophils and epithel ial keratinization;histopathology indicated chronic inflammatory, partly pu rulent subepithelial and stromal conjunctival infiltrate with hyper- and pa rakeratosis fibrous strands and epithelial cell loss; the lower lids showed parakeratosis, focal necrosis, intercellular edema and a lymphohistiocytic round-cell infiltrate. Furthermore, multiple allergies to antibiotics and preservatives (4 x), lacerations of the arms and legs (2 x) and an irritati ve-toxic dermatitis (1 x) were substantiated. In the patients who agreed to a psychiatric consultation, somatized-agitated longing for care combined w ith a dependent and infantile personality (1 x) and reactive depression (2 x) were verified. Conclusions: In patients suffering from treatment-refract ory unilateral chronic blepharokeratoconjunctivitis correlated with the han d, one must take into consideration the fact that other factors may be invo lved: possible exacerbation prior to examinations; multiple inpatient diagn ostic and surgical procedures in different locations; histopathological mix ed inflammatory patterns; and psychiatric syndromes.