Colour Atlas of Ophthalmology by Arthur Lim Siew Ming and Ian J Constable (Auth.)

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By Arthur Lim Siew Ming and Ian J Constable (Auth.)

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Follicles at the limbus leave small depressions known as Herbert's pits, which are perma35 nent diagnostic signs of previous trachoma. A layer of new blood vessels and connective tissue (pannus) usually invades the upper cornea. Healing leads to scars. If compounded by cyclical reinfection and superimposed bacterial infection, entropion (inturned eyelid), trichiasis (inturned eyelashes) and blindness due to opaque cornea or even endophthalmitis may result. In active trachoma, local broad spectrum antibiotics such as tetracycline may be repeated twice a day for six weeks.

44 Raised Conjunctival Lesions Fig. 11 Nasal pterygium encroaching on cornea. Fig. 12 Nasal Pinguecula. (Note: cornea not affected). Fig. 13 Benign melanoma (naevus) of conjunctiva. 45 Corneal Ulcers Fig. 14 Small corneal ulcer caused by staphylococcal infection from use of soft contact lens. Fig. 15 Severe Pseudomonas pyocyaneus corneal ulcer. Fig. 16 Central pneumococcal corneal ulcer with hypopyon (pus in anterior chamber). 46 Corneal Dystrophy Fig. 17 Hereditary corneal dystrophy. Fig. 18 Fuch's corneal dystrophy with diffuse corneal oedema.

The infection may spread backwards and cause cavernous sinus thrombosis, a condition which can be fatal. The patient usually has systemic manifestations of fever and malaise. Treatment is urgent. Intensive medication with systemic antibiotics usually clears the infection. X-ray of the sinuses should be taken and an ear, nose and throat specialist consulted. Exophthalmos (proptosis or forward protrusion of the eyeball) This is recognised clinically by the position of the lower lid margin which normally just covers the limbus but which is separated away in exophthalmos.

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