title: Self-inflicted (factitious) conjunctivitis.
abstract: OBJECTIVE
  To describe the diagnosis and management of self-inflicted factitious conjunctivitis in conscripted soldiers.
  
  
  METHODS
  Prospective, noncomparative, consecutive case series.
  
  
  METHODS
  Seventeen conscripted soldiers.
  
  
  METHODS
  Soldiers with chronic conjunctivitis (>3 weeks) were referred by ophthalmologists, and cases of shorter duration were referred by primary-care physicians. All cases underwent thorough ophthalmic and systemic history and examination, as well as questioning regarding their military units, military duties, and social background. Exclusion criteria were any condition that may cause conjunctivitis. Inferior fornix specimen microscopy and culture and eye photography were performed in most cases. In cases suspected of self-inflicted conjunctivitis all medication, besides lubricant drops, was stopped. Underlying psychosocial problems were investigated and managed. Cases were followed for at least 3 months after resolution of the conjunctivitis, at which point the diagnosis was confirmed, and the case entered the analysis.
  
  
  METHODS
  Resolution of the conjunctivitis.
  
  
  RESULTS
  Seventeen consecutive cases of self-inflicted conjunctivitis, 8 of long duration and 9 of short duration, were studied. All cases demonstrated inconsistent clinical findings. The ocular signs most suggestive of self-inflicted conjunctivitis were purulent discharge purposely left on the lashes and periorbital skin, discharge more severe than in conjunctival hyperemia, less conjunctival chemosis than in hyperemia, mainly inferior conjunctival involvement, and an uninvolved cornea. Five of the 8 chronic cases had significant underlying psychologic or social problems. Their conjunctivitis resolved only after their underlying problems were addressed. Two cases admitted introducing freshly scraped dental plaque into the lower conjunctival sac. In the remaining 15 the similarity of the clinical findings suggested that a similar method was used.
  
  
  CONCLUSIONS
  In the context of a subject standing to gain by assuming the sick role and after exclusion of ocular pathology, self-inflicted conjunctivitis can be reliably diagnosed by noting the characteristic clinical profile. Effective management includes addressing the underlying psychologic and social problems.
authors.affiliation: Medical Corps, Israel Defense Force, Israel.
authors.forename: Russell
authors.initials: R
authors.lastname: Pokroy
authors.forename: Arie
authors.initials: A
authors.lastname: Marcovich
mesh_terms: D000293:Adolescent; D000328:Adult; D003228:Conjunctiva / Q000187:drug effects / Q000293:injuries*; D003231:Conjunctivitis / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005162:Factitious Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011446:Prospective Studies; D012652:Self Mutilation / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology
chemical_list: D009883:Ophthalmic Solutions