title: Persistent conjunctivitis associated with drinking arsenic-contaminated water.
abstract: OBJECTIVE
  The aim of this study was to report on 2 cases of bilateral chronic conjunctivitis that were associated with the drinking of arsenic-contaminated underground water for a long time.
  
  
  METHODS
  Interventional case reports comprised the study.
  
  
  METHODS
  This study was a review of clinical data and laboratory investigations.
  
  
  RESULTS
  Papillary conjunctivitis developed in 2 members of a family who has been drinking underground water for 15 years. There were severe dermatological changes, including hyperkeratosis, on palms and soles, hypo- and hyperpigmented lesions (rain-drop) on the abdomen, chest, and back. Arsenic levels estimated in the nails and hair of both patients were very high. The arsenic level of the drinking water was above the permissible limit. Histopathological examination of conjunctival tissue confirmed the inflammatory response of a papillary type; however, an arsenic estimation in conjunctival tissue was not possible. There were no inclusions of bodies in conjunctival smears stained with hematoxylin and eosin (H&E) stain. There was no response to the usual treatment for papillary conjunctivitis, which only subsided, along with a regression of dermatological changes, when patients were treated with the chelating agent, dimercaprol, and multivitamin preparations, as well as no longer drinking the contaminated water.
  
  
  CONCLUSIONS
  This is a rare association and, to the best of our knowledge, the first report of successful treatment with dimercarpol. The source of arsenic was contaminated underground drinking water (from a deep tube-well). The pathophysiology is thought to be the result of an inflammatory response caused by accumulated arsenic in local tissues. Papillary conjunctivitis and dermatological changes can be successfully managed with dimercaprol and multivitamins. Further studies are required to find out the possible link between the papillary response of conjunctiva and arsenic accumulation within the body.
authors.affiliation: Regional Institute of Ophthalmology, Medical College and Hospitals, Kolkata, West Bengal, India.
authors.forename: Krishnapada
authors.initials: K
authors.lastname: Baidya
authors.forename: Akash
authors.initials: A
authors.lastname: Raj
authors.forename: Lakshmikanta
authors.initials: L
authors.lastname: Mondal
authors.forename: Gautam
authors.initials: G
authors.lastname: Bhaduri
authors.forename: Amit
authors.initials: A
authors.lastname: Todani
mesh_terms: D000293:Adolescent; D000328:Adult; D001151:Arsenic / Q000009:adverse effects*; D003231:Conjunctivitis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D014874:Water Pollutants, Chemical / Q000009:adverse effects*; D014881:Water Supply
chemical_list: D014874:Water Pollutants, Chemical; D001151:Arsenic