Review Question - QID 221319

This patient who recently immigrated to the United States from Africa and now presents with bilateral eye pain, redness, follicular conjunctivitis with involvement of the upper palpebral conjunctiva, and corneal neovascularization most likely has trachoma.

Trachoma is the leading cause of infectious blindness in the world and is caused by Chlamydia trachomatis serotypes A-C. It is endemic to rural parts of South America, Africa, Asia, and Oceania. Trachoma presents acutely with eye pain, redness, and follicular conjunctivitis, inflammation with dome-shaped collections of lymphoid cells that appear as yellow-white elevations with surrounding blood vessels on the superior tarsal conjunctiva. Over time, repeated episodes of active disease may lead to chronic corneal erosions and neovascularization of the superior cornea. Other complications include extensive conjunctival scarring, severe dry eyes, trichiasis, entropion, corneal ulceration, bacterial superinfections, and blindness. Trachoma can be treated with single-dose azithromycin, which should be accompanied by diligent facial hygiene.

Taylor et al. review the epidemiology, pathophysiology, clinical presentation, complications, and treatment of trachoma. They discuss how management includes surgery, antibiotics, facial cleanliness, and environmental improvement. They recommend adopting these strategies in all countries with endemic trachoma.

Figure/Illustration A is a clinical photograph showing numerous dome-shaped, yellow-white elevations of the palpebral conjunctiva (black circle). This finding is consistent with a diagnosis of trachoma.

Incorrect Answers:
Answer 1: Allergic conjunctivitis usually presents bilaterally with itching, watery discharge, a history of allergies, conjunctival injection, and edematous eyelids. Conjunctival papillae (small round bumps) may also be seen on the underside of the eyelid in allergic conjunctivitis.

Answer 2: Gonococcal conjunctivitis is caused by Neisseria gonorrhoeae and is characterized by the hyperacute onset of purulent discharge, marked conjunctival injection, preauricular lymphadenopathy, and lid swelling. It can be acquired either from the birth canal or spread from genital-eye-hand contact in young, sexually active patients. In this older child without the hyperacute onset of symptoms or clear mechanism of transmission, gonococcal conjunctivitis is less likely than trachoma.

Answer 3: Squamous cell carcinoma of the conjunctiva is usually found in older, light-skinned individuals with a long history of sun exposure. It presents as a white or yellow-pink nodule on the conjunctiva and may have surrounding neovascularization.

Answer 5: Viral conjunctivitis may present with bilateral watery discharge, edematous eyelids, and inferior palpebral conjunctival follicles.

Bullet Summary:
Trachoma is caused by infection with Chlamydia trachomatis and presents with follicular conjunctivitis and neovascularization.