Actinic Conjunctivitis and its Relationship with Prurigo in an Indigenous Population from the Highlands of Chiapas, Mexico

Purpose: Actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP), a rare photo dermatosis affecting high-risk populations. We analysed the clinical manifestations and onset of actinic conjunctivitis (AC) and its relationship with prurigo (AP) in a susceptible population. Methods: An observational and cross-sectional study was performed on the Indigenous populations from the highlands of Chiapas, Mexico. A thorough dermatologic and ophthalmologic examination was performed on patients attending a primary health care centre. Clinical features, labour and environmental factors, onset timing, and clinical staging of AC and AP were analysed. Results: Of 2913 patients studied, 54 patients (108 eyes) (1.8%) had AC and 14 patients (25.9%) AP. Mean age of diagnosis was 36.18 ± 18.52 years (range: 6-70 years). Mean residence altitude was 1884 ± 434.2 m above sea level. Mean self-reported sun exposure was 5.14 ± 3.1 hours a day (range: 0.5 - 12 h). 90.7% reported exposure to biomass fuels when cooking, and 50% to farm animals. AC was the sole manifestation in 70% of cases. All patients had nasal and temporal photo-exposed conjunctiva affected. 12.9% of eyes were classified as stage-1, 64.8% as stage-2, and 22.2% stage-3. 83.3% of the patients had a hyperpigmented lesion and 35.1% had an evaporative dry eye disease. Conclusions: The prevalence of AC was 1.8%. AC may be the initial or sole manifestation of AP. AC clinical manifestations included a symmetric papillo-follicular conjunctival reaction, evaporative dry eye disease, linear leucoma, hyperpigmented lesions, and pseudo-pterygia formation.