Follicular Conjunctivitis

What is follicular conjunctivitis?

Follicular conjunctivitis is a type of pink eye (conjunctivitis). It’s a common eye infection.

The conjunctiva is the thin, clear membrane that protects your eye. It covers the inside of your eyelid and the white of your eye (your sclera).

Follicular conjunctivitis gets its name from the specific part of your conjunctiva it affects. Follicles are immune system cells on the inside of your eyelids and in your conjunctiva. When something (usually an infection) irritates these cells, they swell. This inflammation causes the symptoms in your eyes you can see and feel.

Visit an eye care specialist if one or both of your eyes are red, painful or itchy for more than a few days.

What are follicular conjunctivitis symptoms?

The most common follicular conjunctivitis symptoms include:

• Red eye.
• Swollen eyelids (blepharitis).
• Eye pain or irritation.
• Burning eyes.
• Watery discharge or watery eyes (epiphora).
• Feeling like something’s stuck under your eyelid or in your eye (a foreign object sensation).
• Light sensitivity (photophobia).

It usually causes symptoms in both eyes at the same time more often than other types of pink eye.

What causes follicular conjunctivitis?

Follicular conjunctivitis is almost always caused by a viral infection. A virus can either directly infect your eye or spread to your eyes from somewhere else in your body.

Lots of different viruses can cause it, but some of the most common include:

• Adenovirus.
• Herpes simplex.
• Shingles (herpes zoster).
• COVID-19.
• Molluscum contagiosum.
• Picornaviruses.

It’s less common, but the bacterial infection that causes chlamydia can spread to your eyes and cause follicular conjunctivitis. 

Types of follicular conjunctivitis

There are two types:

• Acute follicular conjunctivitis: This is a conjunctivitis that happens because of a one-time, isolated infection that gets better on its own, even without treatment. Around 80% of cases are acute.
• Chronic follicular conjunctivitis: Chronic follicular conjunctivitis happens when an infection lasts longer than usual. Chronic cases need treatment and can last for several weeks.

Can allergies cause follicular conjunctivitis?

Allergies can cause follicular conjunctivitis, but it’s less common than cases caused by infections. Allergies are your body’s reaction to proteins found on things like pollen, pet dander or mold. If an allergen gets in your eyes and your immune system overreacts to it, you may develop follicular conjunctivitis.

Toxic follicular conjunctivitis happens when you have an allergic reaction to a medication (usually eye drops) that causes conjunctivitis.

How is follicular conjunctivitis diagnosed?

An eye care specialist or your primary care provider (PCP) can diagnose follicular conjunctivitis with an eye exam. They’ll look at your eyes, check your vision and ask about the symptoms you’re experiencing. Tell them when you first noticed symptoms, how long you’ve had them and if they’ve gotten more severe over time.

Your provider may do lab tests to diagnose a viral or bacterial infection, but most people don’t need these. It’s more likely that they’ll diagnose follicular conjunctivitis based on your symptoms and medical history.

What are follicular conjunctivitis treatments?

Your eye care specialist or provider will suggest treatments to manage the symptoms you’re experiencing. You may not need any treatment — especially if you have acute follicular conjunctivitis.

If you do need treatment, your provider may suggest:

• Antivirals: These prescription medications treat viral infections. You’ll probably only need them if you have herpes simplex, shingles or COVID-19. 
• Eye drops: Your provider may suggest over-the-counter (OTC) or prescription eye drops to manage symptoms like dry eye and pain. Prescription eye drops may contain medication to treat infections, too.
• Antibiotics: If you have a bacterial infection, you’ll need antibiotics to kill the harmful bacteria in your body.
• Corticosteroids: These prescription anti-inflammatory medications reduce swelling and relieve pain. Your provider may prescribe eye drops to put in your eye or an ointment to rub into the skin around your affected eye.

Can I prevent follicular conjunctivitis?

The best way to prevent follicular conjunctivitis is to reduce your risk of infections. The viruses and bacteria that cause it can spread from person to person, sometimes very easily. Follow these tips to reduce your infection risk:

• Don’t touch or rub your eyes, especially when you’re sick or know you have an infection.
• Wash your hands often. 
• Use a latex condom whenever you have any kind of sex. Use a dental dam for oral sex.

Don’t share items that touch your eyes and face while you’re sick, including:

• Towels.
• Washcloths.
• Cosmetics.
• Eye drops or contact lens supplies.
• Bedding (especially pillowcases).

Is follicular conjunctivitis serious?

Follicular conjunctivitis is usually a mild infection. It’s rare, but some viruses that cause it can permanently damage your eyes and vision if they’re not treated.

That’s why it’s important to see an eye care specialist or another healthcare provider if you notice symptoms that last for more than a few days.

How long does follicular conjunctivitis last?

Most cases of acute follicular conjunctivitis get better in a few weeks. Chronic cases can last longer, sometimes up to a month or more.

You might need to stay home from work, school or other social activities for at least a few days. It depends on which type of infection caused the pink eye. Your eye care specialist will tell you what to expect and when it’s safe for you to resume your usual routine.

When should I see my healthcare provider?

Everyone experiences red eye, itchiness and other symptoms from time to time — especially during allergy seasons. These are common symptoms with lots of causes.

But visit a healthcare provider or eye care specialist if you’ve had symptoms of pink eye for more than a few days.

Let your provider know if follicular conjunctivitis symptoms are lasting longer than they said to expect. This can be a sign of a chronic infection.

Which questions should I ask my provider?

• Which type of follicular conjunctivitis do I have?
• What caused it?
• Will I need treatment?
• How long will the symptoms last?
• When will it be safe for me to go back to work or school?