Review Question - QID 105378

The patient in this vignette most likely has a trachoma, which does not actually infect the eye itself but rather causes physical irritation of the cornea resulting in neovascularization and ultimately blindness.

Trachoma is an ocular manifestation of Chlamydia trachomatis serotypes A-C. Infection leads to eyelid irritation, followed by neovascularization that results in the typical appearance of small, white nodules on the everted eyelid. The gold standard of diagnosis is a Giemsa stain performed on conjunctival scrapings. Treatment involves either topical tetracycline or oral azithromycin. More severe cases with corneal scarring and eyelid inversion may be appropriate for surgical treatment.

Mishori et al. review the diagnosis and treatment of trachoma. Ocular infections with C. trachomatis can manifest as neonatal conjunctivitis, adult conjunctivitis, or trachoma. Trachoma is caused by chronic infection that leads to eyelid scarring and inversion; often, this results in misplacement of the eyelashes such that they consistently scratch the cornea.

Sommer et al. review challenges in providing ophthalmological care in the developing world. They note that trachoma is the leading cause of blindness in the world, affecting roughly 40 million people and causing blindness in nearly 8 million people. They suggest mass-treatment distribution to areas with endemic trachoma.

Figure A displays an example of a trachmoa. Note the small white nodules on the everted eyelid.

Incorrect Answers:
Answer 1: This is the mechanism of herpes simplex keratoconjunctivitis.
Answer 2: C. trachomatis infects the eyelid but does not directly infect the cornea.
Answer 3: Fungal infection is not the mechanism of trachoma formation.
Answer 4: This is the mechanism of pterygium formation.