A Clinical Case from the Archives : 29/09/2004

What are the abnormalities in this eye? Might they be connected?

Working logically, the first thing to note is the upper eyelid defect with loss of the normal eyelid margin and resultant trichiasis with hair abrading the cornea – possibly post-traumatic but more likely a congenital defect. The other obvious lesion is the corneal ulcer – here made more obvious after the administration of topical fluorescein. It may be that the eyelid margin defect has led to the ulcer, or at the very least prevented it from healing even it is hasn’t caused it in the first place. Topical antibiotis and ocular surface protection with a contact lens might well be appropriate therapeutic measures. Note also that the iris is dark and there is a synechium and a hazy pupil with aqueous flare (difficult to see on this picture I’ll admit). Those signs suggest uveitis probably consequent to corneal irritation. Treatment with topical NSAID (not steroid as there is an ulcer) and atropine would also be worthwhile.


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