Usually, the patient is asymptomatic. Concretions are usually detected incidentally when the eye is examined for some other purpose.

When large, they may become symptomatic. The patient may present with complaints of:

• Irritation
• A foreign body sensation that can usually localize to a specific point
• Tearing
• Redness
• Photophobia (usually with large concretions on the upper tarsal conjunctiva that rub against the cornea
• Photophobia
• Blurry vision

A diagnosis is made upon clinical examination with eversion of the eyelids and examination under the biomicroscope. Concretions may be single or multiple. They present as yellowish-white structures located in the palpebral conjunctiva or fornices. They may become confluent, and these, as well as the larger ones, may erode through the conjunctiva and protrude to become symptomatic. The surrounding conjunctiva may show signs of allergy-like follicles and redness.

If the patient is asymptomatic and the finding of concretions is incidental, it is best not to perform any procedures. Most concretions remain asymptomatic and do not need a specific treatment.

If the patient is symptomatic, the specific concretions may be removed.

Method of removal: Proparacaine hydrochloride 0.5% drops are instilled, and the lid is everted to expose the palpebral conjunctival surface. Applying the anesthetic via a Q-tip soaked with the anesthetic on the concretion is useful in achieving better local anesthesia. The concretions may either be removed using a 26G or 30G needle with bevel away from tarsus and just nudging the concretion at one end and lifting it from the conjunctiva. Fine-tipped forceps may also be used. Mild oozing is common and is easily controllable with simple local pressure. A topical antibiotic drop or ointment is administered. If there has been a breakdown of the corneal surface, a few days of antibiotic drops or ointment are prescribed. 

Three entities require differentiation from the conjunctival concretion:

• Conjunctival foreign body: if small and buried in the conjunctiva with a part protruding from the conjunctiva the foreign body may mimic a concretion
• Epidermal inclusion cyst: can be congenital or acquired. These are cystic lesions in the subepithelium space but have clear fluid, unlike concretions that are solid and filled with keratin.[7]
• Lymphoid follicle: these are also found in the subepithelial space but are usually diffuse and multiple. Histologically they have central immature lymphocytes and surrounding mature cells.[8]
• Rarely with ophthalmia nodosa: ophthalmia nodosa is a conjunctival or corneal inflammatory response to hair, caterpillar spines, and other foreign bodies. They may also cause multiple linear abrasions on the cornea. However, unlike with concretions, these eyes show more inflammation and a granulomatous reaction around the foreign body. [9] Pagenstecher, in 1883, described the first case of ophthalmia nodosa and termed the disease "caterpillar hair ophthalmia." Wagenmann reported a case in 1890, and mistakenly called it pseudotuberculosis. Saemisch, in 1904, gave the condition the correct name. In the early 20th Century, the condition was termed "nursemaid's disease" because of the frequency with which nursemaids who sat under the trees in Hyde Park as they watched children became afflicted by urticaria and conjunctivitis caused by hairs from the vapourer moth (Orgyn antiqua). 

Conjunctival concretions are a benign condition. Treatment of symptomatic lesions offers a cure. If the concretions are associated with inflammation or allergy, appropriate treatment for these conditions is necessary to prevent a recurrence. It is wise not to remove asymptomatic concretions. 

Conjunctival concretions are rarely associated with complications. Corneal abrasion caused by prominent concretions can cause irritation, pain, photophobia, redness, blurring of vision or corneal ulceration, and dry eye.[10]

A diagnosis of concretions is usually made incidentally during a routine eye examination under the biomicroscope. Once diagnosed, the clinician should reassure the patient that the condition is entirely benign. Asymptomatic patients can undergo observation. In the presence of a foreign body sensation, irritation, redness, or watering, these concretions can be necessary. Removal of concretions is performed with a topical anesthetic in an outpatient setting, usually in the clinic. Recovery is generally rapid, with little discomfort. Recurrence of concretions may occur, especially if there is associated inflammation. 

Ophthalmologists or optometrists are the first to diagnose conjunctival concretions. The diagnosis requires confirmation with slit-lamp biomicroscopy. The benign nature of the condition should be stressed. The healthcare team consisting of ophthalmologists, optometrist, nurse, and pharmacist should all be aware of the condition, how to diagnose, and the treatment options available for the condition. However, treatment should only be by a trained ophthalmologist.  Not all cases require treatment, just symptomatic cases. Histopathology is usually not necessary. The excellent prognosis should be discussed with the patient.