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The conjunctivitis leads to bipolar depression lingers order zyban 150mg with amex progressive scarring mood disorder jokes discount 150 mg zyban overnight delivery, obliteration of the fornices (especially the lower fornix) bipolar depression 39 order cheapest zyban and zyban, symblepharon formation (Figure 5� 17), and entropion with trichiasis. The cornea is affected only secondarily as a result of trichiasis 236 and lack of the precorneal tear film. The disease is often more severe in women than in men and typically occurs in middle life, very rarely before age 45. In women, it may progress to blindness in a year or less; in men, progress is slower, and spontaneous remission sometimes occurs. Conjunctival biopsies may contain eosinophils, and the basement membrane will stain positively with certain immunofluorescent stains (IgG, IgM, IgA complement). The secondary consequences, such as tear deficiency, trichiais, and ocular toxicity need to be recognized and treated appropriately. Generally, the course is long and the prognosis poor, with blindness due to complete symblepharon and corneal desiccation. Silver nitrate instilled into the conjunctival sac at birth (Crede prophylaxis) is a frequent cause of mild chemical conjunctivitis. If tear production is reduced by continual irritation, the conjunctiva can be further damaged by the lack of dilution of the noxious agent as it is instilled into the conjunctival sac. Conjunctival scrapings often contain keratinized epithelial cells, a few polymorphonuclear neutrophils, and an occasional oddly shaped cell. Treatment consists of stopping the offending agent and using bland drops or none at all. Often the conjunctival reaction persists for weeks or months after its cause has been eliminated. Some common irritants are fertilizers, soaps, deodorants, hair sprays, tobacco, makeup preparations (mascara, etc), and various acids and alkalies. In certain areas, smog has become the most common cause of mild chemical conjunctivitis. The specific irritant in smog has not been positively identified, and treatment is nonspecific.

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