Review Question - QID 106991

This patient's clinical presentation is consistent with trachoma, which is treated with topical tetracycline.

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 (Illustration A). 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. Occular infections with Chlamydia trachomatis can manifest as neonatal conjunctivitis, adult conjunctivitis, or trachoma. Trachoma is caused by chronic infection that leads to eyelid scarring and inversion, and often results in misplacement of the eyelashes such that they consistently scratch the cornea.

Sommer et al. review challenges in giving 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 shows trachomatous follicles on the internal eyelid that can be seen with eyelid eversion. Illustration A shows a Giemsa stain of Chlamydia trachomatis.

Incorrect Answers:
Answer 2: Topical vidarabine is an antiviral medication that is used for treatment of ocular herpes simplex infection.
Answer 3: Topical steroids are used as treatment for uveitis.
Answer 4: Oral antihistamines are used for treatment of allergic conjunctivitis.
Answer 5: Surgical removal is used as the treatment for pterygium.