CASE REPORT

A five-year-old female Sudanese refugee presented to our clinic for evaluation of her left eye. Her father reported worsening of vision over the past two years. On examination, the left eye showed corneal opacity with blurring of the pupillary margin (Figure 1). Distortion of the tarsal conjunctiva was noted, resulting in entropion and redirection of the lower lashes inward (arrow). The patient was diagnosed with trachoma.

Figure 1

Entropion, trichiasis, and corneal opacity

Trachoma is the leading cause of infectious blindness worldwide.Reference Resnikoff, Pascolini and Etya’ale ¹ Trachoma is endemic in parts of Africa, the Middle East, and India. The disease is particularly problematic in certain regions of Ethiopia and Sudan, where up to 50% of children have active trachoma.Reference Berhane, Worku and Bejiga ² The causative organism, Chlamydia trachomatis, is spread through direct or indirect contact with eye discharge of an infected person. Children in endemic areas often suffer multiple episodes of infection, leading to chronic follicular conjunctivitis that sets off a cascade of events including conjunctival scarring, entropion, trichiasis, and corneal abrasion.Reference Solomon, Peeling and Foster ³ If untreated, this condition leads to the formation of irreversible corneal opacities and blindness.

The differential diagnosis includes viral and bacterial causes of conjunctivitis, as well as involutional changes—rare in trachoma-endemic regions. Treatment is with oral azithromycin, topical tetracycline, and corrective surgery for inturned eyelashes. Depending on local prevalence rates, treatment is targeted towards the individual patient, or towards the population as a whole. The “SAFE” acronym was developed by the World Health Organization to guide international efforts at prevention and treatment: Surgery for inturned lashes, Antibiotics, Facial cleanliness, and Environmental improvement. ⁴