Background/Aims: 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. Conclusion: 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.

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