| Abstract: | Summary
Autoaggressive syndromes as causes of diseases underlying chronic blepharitis and keratoconjunctivitis that are refractory
to treatment are often difficult to recognize.
Patients: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4 × ) or left-(1
× ) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2 ,11 and 30 months prior to admission. In each case more
than 5 ophthalmologists and 2–6 eye hospitals had been consulted, and extraocular surgery had been performed 1–4 times.
Results: Patients presented with a visual acuity of 0.3 p (1 × ), 0.1 (1 × ), FC (1 × ), HM (1 × ). In three patients contact eczema
of the facial skin and lids and a corneal pannus were observed; in two patients we saw purulent pseudomembranous and in two
patients chronic cicatrizing keratoconjunctivitis. Conjunctival smears grew P. aeruginosa, and S. aureus; impression cytology showed infiltration with neutrophils and epithelial keratinization; histopathology indicated chronic
inflammatory, partly purulent subepithelial and stromal conjunctival infiltrate with hyper- and parakeratosis 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 × ), lacerations of the arms and
legs (2 × ) and an irritative-toxic dermatitis (1 × ) were substantiated. In the patients who agreed to a psychiatric consultation,
somatized-agitated longing for care combined with a dependent and infantile personality (1 × ) and reactive depression (2
× ) were verified.
Conclusions: In patients suffering from treatment-refractory unilateral chronic blepharokeratoconjunctivitis correlated with the hand,
one must take into consideration the fact that other factors may be involved: possible exacerbation prior to examinations;
multiple inpatient diagnostic and surgical procedures in different locations; histopathological mixed inflammatory patterns;
and psychiatric syndromes.
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