Symptoms
- In the absence of secondary infection, symptoms are minimal and include mild foreign body sensation in the eyes, occasional lacrimation, slight stickiness of the lids and scanty mucoid discharge.
- In the presence of secondary infection, typical symptoms of acute mucopurulent conjunctivitis develop.
Signs
A. Conjunctival signs
1. Congestion of upper tarsal and forniceal conjunctiva.
2. Conjunctival follicles. Follicles (Fig. 1 and Fig.2) look like boiled
sagograins and are commonly seen on upper tarsal conjunctiva and fornix; but may also be present in the lower fornix, plica semilunaris and caruncle. Sometimes,
(follicles may be seen on the bulbar conjunctiva (pathognomic of trachoma).
follicular conjunctivitis.
A. Conjunctival signs
1. Congestion of upper tarsal and forniceal conjunctiva.
2. Conjunctival follicles. Follicles (Fig. 1 and Fig.2) look like boiled
sagograins and are commonly seen on upper tarsal conjunctiva and fornix; but may also be present in the lower fornix, plica semilunaris and caruncle. Sometimes,
(follicles may be seen on the bulbar conjunctiva (pathognomic of trachoma).
follicular conjunctivitis.
 |
| Fig. 1. Signs of active traochoma (diagramatic). |
 |
| Fig. 2. Trachomatous inflammation follicular (TF) |
3. Papillary hyperplasia. Papillae are reddish, flat topped raised areas which give red and velvety appearance to the tarsal conjunctiva (Fig. 3). Each papilla consists of central core of numerous dilated blood vessels surrounded by lymphocytes and covered by hypertrophic epithelium.
 |
| Fig. 3. Trachomatous inflammation intense (TI) |
4. Conjunctival scarring (Fig. 4), which may be irregular, star-shaped or linear. Linear scar present in the sulcus subtarsalis is called Arlt's line.
5. Concretions may be formed due to accumulation
of dead epithelial cells and inspissated mucus in
the depressions called glands of Henle.
 |
| Fig. 4. Trachomatous scarring (TS) |
5. Concretions may be formed due to accumulation
of dead epithelial cells and inspissated mucus in
the depressions called glands of Henle.
1. Superficial keratitis may be present in the upper
part.
2. Herbert follicles refer to typical follicles present
in the limbal area. These are histologically similar
to conjunctival follicles.
3. Pannus i.e., infiltration of the cornea associated
with vascularization is seen in upper part (Fig. 5). The vessels are superficial and lie between epithelium and Bowman's membrane. Later on
Bowman's membrane is also destroyed. Pannus
may be progressive or regressive.
with vascularization is seen in upper part (Fig. 5). The vessels are superficial and lie between epithelium and Bowman's membrane. Later on
Bowman's membrane is also destroyed. Pannus
may be progressive or regressive.
- In progressive pannus, infiltration of cornea is ahead of vascularization.
- In regressive pannus (pannus siccus) vessels extend a short distance beyond the area of infiltration.
A B 
(c)Fig. 5. Trachomatous pannus : (A) progressive,
(B) regressive (diagramatic) and (C) clinical photograph
4. Corneal ulcer may sometime develop at the
advancing edge of pannus. Such ulcers are usually
shallow which may become chronic and indolent.
5. Herbert pits are the oval or circular pitted
scars, left after healing of Herbert follicles in the
limbal area (Fig. 6).
6. Corneal opacity may be present in the upper
part. It may even extend down and involve the
pupillary area. It is the end result of trachomatous
corneal lesions.
advancing edge of pannus. Such ulcers are usually
shallow which may become chronic and indolent.
5. Herbert pits are the oval or circular pitted
scars, left after healing of Herbert follicles in the
limbal area (Fig. 6).
 |
| Fig. 6. Trachomatous Herbert's pits. |
6. Corneal opacity may be present in the upper
part. It may even extend down and involve the
pupillary area. It is the end result of trachomatous
corneal lesions.
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