|Year : 1958 | Volume
| Issue : 2 | Page : 35-36
Follicular conjunctivitis simulating early trachoma - report of a case
|Date of Web Publication||8-May-2008|
E J Somerset
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Somerset E J. Follicular conjunctivitis simulating early trachoma - report of a case. Indian J Ophthalmol 1958;6:35-6
Most cases of follicular conjunctivitis and trachoma present little difficulty in differentiation to the experienced ophthalmologi Nevertheless, one occasionally sees very early cases in which the diagnosis may be in doubt. Such is the following case which may therefore be of interest.
| Case History|| |
R. A., a school boy aged 13 years, was first seen in January 1957 complaining of excessive blinking and irritation of both eyes for the past two months. He had been diagnosed as a case of trachoma and given 30% sulphacetamide eye drops and subsequently aureomycin ointment but the latter had only been used for 10 days.
He comes of a respectable moderately prosperous Anglo-Indian family and was born in Calcutta where trachoma amongst the indigenous population is not common. He has lived in Calcutta all his life except for 2 years from the age of 1 to 3 years when he was in Amritsar (Punjab). His mother looked after him and he had no ayah.
Examination revealed normal vision and normal eyes except for follicles of the upper and lower lids. The follicles were in greater numbers on the upper tarsal conjunctiva, they were separate and many had the yellowish appearance of early trachoma follicles. There was no pannus even on the most minute examination. There was no pavement effect and the condition was quite unlike spring catarrh, though it was extraordinarily suggestive of trachoma.
Scrapings from the upper tarsal conjunctiva were made and the pathological report was "A fair number of pus cells, epithelial cells and an occasional eosinophil present. A few gram positive cocci present. No inclusion bodies seen."
In view of the clinical appearance, particularly the absence of pannus, the history of 2 months duration, his family background and the fact that he had lived in Calcutta for the past 10 years, he was diagnosed as a case of follicular conjunctivitis.
Confidence was, however, slightly shaken by the history of his brother, which was as follows :-
His brother who is 2 years older than he, was investigated at a hospital in 1955 for fits. During the investigation he attended the eye department for field examination etc., and was noticed to have sore eyes. Trachoma II was diagnosed and he was treated for this for about 6 months. He was given albucid, acromycin and chloromycetin by local applications. Examination now hows no tarsal scarring or evidence of former pannus.
In order to prove the diagnosis he was given no specific trachoma treatment but only put on zinc sulphate drops.
He was re-examined at 2-weekly intervals for 12 weeks, and the condition remained stationary. No pannus appeared. He was then put on Oc. Chloromycetin with hydrocortisone (P. D. & Co.) for 1 month and was not improved. He stated that his eyes felt rather sore so he was put back on to the zinc ¼% drops, which had given him some relief. This was the only treatment he had for nine months. He became symptomless and when examined nine months from the time he was first seen, he showed slight folliculosis but no pannus. A few prominent nerve fibers could be seen in the cornea on slit-lamp examination.
| Comment|| |
The follicles of the upper lid were clinically very like trachoma follicles and his brother had been diagnosed as a case of trachoma 2 years before. However, with a history of 2 months there was no pannus and this did not develop during the next nine months during most of which time he was only given zinc drops and the condition has spontaneously regressed. This is quite unlike trachoma. It is a common observation to see better class patients who have lived the early parts of their lives in areas where trachoma is endemic and who show unmistakable signs of former trachomatous infection. In spite of no history of ocular symptoms or treatment they show slight tarsal scarring and definite pannus. This may be so tenuous as to only be seen satisfactorily by retro -illumination but which is nevertheless always present. With the advent, during the last few years, of the treatment of trachoma by aureomycin and terramycin, it is possible that in future we shall see adults who have been infected with trachoma in childhood and who, as the result of modern treatment, recover without leaving any scarring or pannus. As far as I know, before this treatment trachoma always resulted in permanent though often faint diagnostic signs.
This case seems to show that it is unwise to diagnose or treat a case as trachoma unless and until pannus appears.
It would be interesting to establish the maximum duration of Stage I trachoma before the appearance of pannus.