"Blue-body" epithelial cell inclusions in conjunctivitis.

In 10.4% of conjunctival scrapings received from 1731 patients with conjunctivitis during the years 1970 through 1980, basophilic cytoplasmic inclusions of unknown etiology were found in the epithelial cells when Giemsa stained. These "blue-bodies" differed in morphology from bacteria, chlamydia, and other frequent cytoplasmic inclusions. By electron microscopy, they consisted of a variety of dense bodies and phagolysosomal vacuoles containing complex lipids, indicating injury to the epithelial cells. The presence of these inclusions had a statistically significant association with the use of topical medications, especially Neosporin. Administration of other antibiotics and medications was less frequently related. Patients with the most prolific "blue-body" inclusions usually showed a clinical picture of subacute to chronic conjunctivitis or blepharoconjunctivitis thought to represent hypersensitivity. Recognizing the nature of these easily seen inclusions is important to distinguish them from infectious organisms, and may also support the diagnosis of a drug-related reaction.