Cornea/Refractive Surgery Quiz 11

Yichieh Shiuey, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

December 17, 1996
Figure 1
Figures 1-3. Figures 1-2 SHOW the everted lids of a woman with chronic conjunctivitis FROM North Africa which demonstrate linear subconjunctival scarring. Figure 3 shows high powered views which reveal perilimbal depressions
Figure 2
Figure 3

Case History
Longstanding trachoma is a much more difficult condition to manage. Surgery to REPAIR lid deformities and corneal transplants are potential options, but are unavailable to the populations afflicted with trachoma. In those, countries prevention is the only treatment.
Questions and Answers
1. What is the cause of this woman's chronic conjunctivitis?
Answer: Trachoma

2. What is the eponym for the finding in figures 1-2?
Answer: Arlt's lines

3. What is the eponym for the finding in figure 3 and what does this finding represent?
Answer: Herbert's pits. These are cicatrized perilimbal follicles.

4. How do you make the diagnosis of this condition?
Answer: In endemic areas, diagnosis is usually on clinical grounds alone. However, the diagnosis can be confirmed by Giemsa staining of conjunctival scrapings which will demonstrate intra-cytoplasmic inclusion bodies. A negative result on a Giemsa stain is not clinically useful, however, since the false negative rate can be as high as 70-90%. A more recent technique is fluorescent monoclonal antibody staining e.g. Micro-Trak, which has both high sensitivity (94%) and high specificity (88%) for chlamydia.

5. How is this condition treated?
Answer: Treatment of acute trachoma is straight forward. Systemic therapy with oral tetracycline 1.0 - 1.5 g daily or oral doxycycline100 mg bid for two weeks is usually curative. Topical antibiotics are not necessary if systemic antibiotics are given. If the patient is a child or a pregnant woman, systemic erythromycin may be substituted.