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er pathologies
Other pathologies
Onchocerciasis (river blindness)
O c u la r le s ions r e s u lt fr om t h e in v a s ion of th e e ye b y m ic r ofila r ia e . Th e y
ge n e r a lly
d e v e lop in a d u lts a nd p r ogr e s s to b lind ne s s in the a b s e nc e of e a r ly tr e a tm e nt.
Clinical features and treatment
O c u la r le s ions a r e a lw a ys a s s oc ia te d w ith onc hoc e r c a l s kin le s ions (s e e
p a ge 1 5 7 ).
– P r u r itu s , he m e r a lop ia (c r e p u s c u la r b lind ne s s ), d e c r e a s e in v is u a l a c u ity,
–naL rer oswioninsg of th e c or n e a ( p u n c tu a te , th e n s c le r os in g, ke r a tit is ) , ir is ( ir id oc yc litis )
the v is u a l fie ld , a w a r e ne s s of m ic r ofila r ia e in the v is u a l fie ld (the p a tie nt
s e e s “little
w iggling w or m s b e for e his e ye s ” ).
p os te r ior s e gm e n t ( c hor ior e tinop a th y a n d op tic a tr op h y) ; m ic r ofila r ia e w ith in
the
a nte r ior c ha m b e r or v itr e ou s hu m or (s lit la m p ).
F or tr e a tm e nt, s e e Onchocerciasis, p a ge 1 5 7 . I v e r m e c tin tr e a tm e nt m a y
im p r ov e a nte r ior
s e gm e n t le s ion s ( s c le r os in g ke r a titis , ir id oc yc litis ) a nd v is u a l a c u it y. S e v e r e
le s ions
(c hor ior e tina l le s ions , op tic a tr op hy) c ontinu e to p r ogr e s s d e s p ite tr e a tm e nt.
Loiasis
Clinical features and treatment
M igr a tion of a n a d u lt w or m u nd e r the p a lp e b r a l or b u lb a r c onju nc tiv a (w hite ,
filifor m
w or m , m e a s u r in g 4 t o 7 c m in le n gt h , m ob ile ) a n d oc u la r p r u r it u s ,
la c r im a t ion ,
p hotop hob ia or e ye lid oe d e m a .
F or tr e a tm e nt, s e e Loiais, p a ge 1 5 9 . The m igr a tion of the w or m is ofte n of v e r y
b r ie f
d u r a tion. D o not a tte m p t to e xtr a c t it, or a d m inis te r a na e s the tic d r op s ; s im p ly
reassu re
the p a tie n t, th e e v e n t is h a r m le s s . S u r gic a l r e m ov a l is like w is e fu tile if the
w or m is
d e a d / c a lc ifie d .
Pterygium
A w h it is h , t r ia n gu la r gr ow t h of fib r ov a s c u la r t is s u e e xt e n d in g s low ly fr om
the
c on ju nc tiv a to th e c or ne a . I t oc c u r s m os t fr e q u e n tly in p a tie nts w ho a r e
e xp os e d to
w ind , d u s t, or a r id c lim a te s a nd ne v e r d is a p p e a r s s p onta ne ou s ly.
Clinical features and treatment
Tw o s ta ge s :
– B e nign p te r ygiu m d e v e lop s s low ly, d oe s not r e a c h the p u p il: no tr e a tm e nt.
– P r ogr e s s iv e v a s c u la r ize d p te r ygiu m : r e d a nd infla m e d gr ow th c ov e r s the
p u p il a nd
Other pathologies
Onchocerciasis (river blindness)
O c u la r le s ions r e s u lt fr om t h e in v a s ion of th e e ye b y m ic r ofila r ia e . Th e y
ge n e r a lly
d e v e lop in a d u lts a nd p r ogr e s s to b lind ne s s in the a b s e nc e of e a r ly tr e a tm e nt.
Clinical features and treatment
O c u la r le s ions a r e a lw a ys a s s oc ia te d w ith onc hoc e r c a l s kin le s ions (s e e
p a ge 1 5 7 ).
– P r u r itu s , he m e r a lop ia (c r e p u s c u la r b lind ne s s ), d e c r e a s e in v is u a l a c u ity,
–naL rer oswioninsg of th e c or n e a ( p u n c tu a te , th e n s c le r os in g, ke r a tit is ) , ir is ( ir id oc yc litis )
the v is u a l fie ld , a w a r e ne s s of m ic r ofila r ia e in the v is u a l fie ld (the p a tie nt
s e e s “little
w iggling w or m s b e for e his e ye s ” ).
p os te r ior s e gm e n t ( c hor ior e tinop a th y a n d op tic a tr op h y) ; m ic r ofila r ia e w ith in
the
a nte r ior c ha m b e r or v itr e ou s hu m or (s lit la m p ).
F or tr e a tm e nt, s e e Onchocerciasis, p a ge 1 5 7 . I v e r m e c tin tr e a tm e nt m a y
im p r ov e a nte r ior
s e gm e n t le s ion s ( s c le r os in g ke r a titis , ir id oc yc litis ) a nd v is u a l a c u it y. S e v e r e
le s ions
(c hor ior e tina l le s ions , op tic a tr op hy) c ontinu e to p r ogr e s s d e s p ite tr e a tm e nt.
Loiasis
Clinical features and treatment
M igr a tion of a n a d u lt w or m u nd e r the p a lp e b r a l or b u lb a r c onju nc tiv a (w hite ,
filifor m
w or m , m e a s u r in g 4 t o 7 c m in le n gt h , m ob ile ) a n d oc u la r p r u r it u s ,
la c r im a t ion ,
p hotop hob ia or e ye lid oe d e m a .
F or tr e a tm e nt, s e e Loiais, p a ge 1 5 9 . The m igr a tion of the w or m is ofte n of v e r y
b r ie f
d u r a tion. D o not a tte m p t to e xtr a c t it, or a d m inis te r a na e s the tic d r op s ; s im p ly
reassu re
the p a tie n t, th e e v e n t is h a r m le s s . S u r gic a l r e m ov a l is like w is e fu tile if the
w or m is
d e a d / c a lc ifie d .
Pterygium
A w h it is h , t r ia n gu la r gr ow t h of fib r ov a s c u la r t is s u e e xt e n d in g s low ly fr om
the
c on ju nc tiv a to th e c or ne a . I t oc c u r s m os t fr e q u e n tly in p a tie nts w ho a r e
e xp os e d to
w ind , d u s t, or a r id c lim a te s a nd ne v e r d is a p p e a r s s p onta ne ou s ly.
Clinical features and treatment
Tw o s ta ge s :
– B e nign p te r ygiu m d e v e lop s s low ly, d oe s not r e a c h the p u p il: no tr e a tm e nt.
– P r ogr e s s iv e v a s c u la r ize d p te r ygiu m : r e d a nd infla m e d gr ow th c ov e r s the
p u p il a nd
