title: Factitious pseudo-membranous conjunctivitis in an adolescent boy.
abstract: OBJECTIVE
  Ocular factitious lesions involving the conjunctiva alone represent a challenging diagnosis for the ophthalmologist; corneal integrity, in fact, allows maintenance of good visual acuity and precludes the pain subsequent to trigeminal stimulation. Conjunctival biopsy is crucial to make a diagnosis and to focus on possible peculiarities in the patient's behavior. A psychiatrist has to confirm the diagnosis. In this case report, images of a bilateral pseudo-membranous conjunctivitis sparing the cornea in an anorexic adolescent boy are shown.
  
  
  METHODS
  Photographically documented case report.
  
  
  RESULTS
  A fourteen-year-old Italian boy was referred with a diagnosis of bilateral chronic conjunctivitis unresponsive to systemic and topical antibiotic and steroidal treatment. It had lasted for 4 months and was concomitant with an 8-kg weight loss. Conjunctival biopsy revealed cotton wool fragments. The patient admitted an unsafe behaviour lasting for months. A diagnosis of factitious conjunctivitis was made, and confirmed by a psychiatric assessment.
  
  
  CONCLUSIONS
  Factitious lesions of the eye involve not only anatomical structures situated on the visual axis causing a reduction of visual acuity, but may also involve the conjunctiva alone. A thorough clinical history should identify the source of the patient's anxiety. Moreover, close cooperation between ophthalmologists and a psychiatrist can further clarify the diagnosis.
authors.affiliation: Institute of Ophthalmology, University of Parma, Agrigento, Italy.
authors.forename: Jelka G
authors.initials: JG
authors.lastname: Orsoni
authors.forename: Pierangela
authors.initials: P
authors.lastname: Rubino
authors.forename: Isabella
authors.initials: I
authors.lastname: Pellistri
authors.forename: Chiara
authors.initials: C
authors.lastname: Menozzi
authors.forename: Laura
authors.initials: L
authors.lastname: Zavota
authors.forename: Antonino
authors.initials: A
authors.lastname: Massaro
authors.forename: Paolo
authors.initials: P
authors.lastname: Mora