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  • Grand Rounds

    A patient with a past medical history of hematologic abnormalities undergoing workup for malignancy presented with chronic conjunctival hyperemia and a conjunctival lesion in the left eye. Slit lamp exam was notable for mild injection and irregular, bumpy conjunctiva. He underwent conjunctival biopsy and anterior segment OCT. OCT showed a heterogenous epithelial lesion with areas of hyperreflectivity. Biopsy revealed chronic lymphoplasmacytic inflammation. Biopsy and OCT were not consistent with an infiltrative or neoplastic process. Bone marrow biopsy revealed chronic myelomonocytic leukemia-1. He continued to have symptoms and presented two months later with significant folliculopapillary reaction, mucopurulent conjunctivitis, and presence of pseudomembrane. His culture grew S. aureus. He was started on topical vancomycin and steroids but was still symptomatic at follow up. Detailed exam revealed abnormally deep fornices. A diagnosis of Giant Fornix Syndrome was made as the cause of chronic bacterial conjunctivitis. Pseudomembranes were debrided and washed with povidone iodine. Topical vancomycin and steroids were increased and extended. He required debridement of pseudomembranes again at follow up visit. After about six months, his conjunctivitis resolved. He has not had recurrence since.

    Presentation Date: 09/07/2023
    Issue Date: 09/22/2023