The aim of this study is to demonstrate the spectrum of conditions encompassed by the term ‘trachomatous cicatrization of eyelid tissue’, to discuss the mechanisms of scar tissue formation and to describe sequelae in this potentially blinding condition. Specimens of eyelid tissues were taken from 27 upper eyelids of 21 patients with entropion who underwent surgical procedures and 2 post-mortem upper eyelids with severe trachomatous entropion. Upper palpebral conjunctival swabs and biopsy specimens were taken from 5 patients with active trachoma and they were examined by fluorescence microscopy and routine histopathological methods. Conjunctival impression cytology samples were collected in all patients. In specimens taken from patients with active trachoma the inflammatory infiltrate was organized as lymphoid follicles in the underlying stroma and impression cytology showed cytoplasmic elementary bodies. In specimens taken from patients with scarring trachoma light microscopy studies showed subepithelial fibrous membrane formation, squamous metaplasia and loss of goblet cells, pseudogland formation in conjunctiva, degeneration of orbicularis oculi muscle fibres, subepithelial vascular dilatation, localized perivascular amyloidosis and subepithelial lymphocytic infiltration. Accessory lachrymal glands and the ducts of glands were compromised by subepithelial infiltration and scarring. The contraction of the subepithelial fibrous tissue formed by collagen fibres and anterior surface drying are the main factors contributing to the chronic cicatrization and entropion formation.

Darougar S: The humoral immune response to chlamydial infection in humans. Rev Infect Dis 1985;7:726–730.
el-Asrar AMA, Van den Oord JJ, Geboes K, Missotten L, Emarah MH, Desmet V: Immunopathology of trachomatous conjunctivitis. Br J Ophthalmol 1989;73:276–282.
Lewallen S, Courtright P: Anatomical factors influencing development of trichiasis and entropion in trachoma. Br J Ophthalmol 1991;75:713–714.
Young E, Taylor HR: Immune mechanisms in chlamydial eye infection: Cellular immune responses in chronic and acute disease. J Infect Dis 1984;150:745–751.
Taylor HR, Johnson SL, Prendergast RA, Schachter J: An animal model of trachoma. II. The importance of repeated reinfection. Invest Ophthalmol Vis Sci 1982;23:507–515.
Taylor HR: Ocular models of chlamydial infection. Rev Infect Dis 1985;7:737–740.
Brunham RC, Peeling RW: Chlamydia trachomatis antigens: Role in immunity and pathogenesis. Infect Agents Dis 1994;3:218–233.
Dawson CR: Pathogenesis and control of blinding trachoma; in Tasman W, Jaeger EA (eds): Duane’s Clinical Ophthalmology, Philadelphia, Lippincott-Raven, 1991, vol. 5, chap 60, pp 2–4.
Whittum-Hudson J, Taylor HR, Farazdaghi M, Prendergast RA: Immunohistochemical study of the local inflammatory response to chlamydial ocular infection. Invest Ophthalmol Vis Sci 1986;27:64–69.
Al-Rajhi AA, Hidayat A, Nasr A, Al-Faran M: The histopathology and the mechanism of entropion in patients with trachoma. Ophthalmology 1993;100:1293–1296.
Tseng SCG: Staging of conjunctival squamous metaplasia by impression cytology. Ophthalmology 1985;92:728–733.
Nasr A: Eyelid complications in trachoma: Diagnosis and management. Acta Ophthalmol 1991;69:200–204.
Kunimoto D, Brunham RC: Human immune response and Chlamydia trachomatis infection. Rev Infect Dis 1985;7:665–673.
Monnickendam MA, Pearce JH: Immune responses and chlamydial infections. Br Med Bull 1983;39:187–193.
Bernauer W, Broadway DC, Wright P: Chronic progressive conjunctival cicatrization. Eye 1993;7:371–378.
Kovaks EJ: Fibrogenic cytokines: The role of immune mediators in the development of scar tissue. Immunol Today 1991;12:17–23.
Taylor HR, Johnson SL, Schacter J: Pathogenesis of trachoma: The stimulus for inflammation. J Immunol 1987;138:3023–3027.
Grayston JT, Wang S, Yeh L, Kuo C: Importance of reinfection in the pathogenesis of trachoma. Rev Infect Dis 1985;7:717–725.
Brunham RC, Plummer F, Stephens RS: Bacterial antigenic variation, host immune response and pathogen-host co-evolution. Infect Immun 1993;61:2273–2276.
Baudouin C, Haouat N, Brignole F, Bayle J, Gastaut P: Immunopathological findings in conjunctival cells using immunofluorescence staining of impression cytology specimens. Br J Ophthalmol 1992;76:545–549.
Guzey M, Basar E, Ermis SS, Bitiren M, Ozardali I, Mirzatas C: Pretarsal and marginal orbicularis oculi muscle fiber changes in trachomatous cicatricial entropion: Histopathological evaluation. Eur J Ophthalmol 1999;9:89–92.
Halasa AH, Jarudi N: Tarsotomy for the correction of cicatricial entropion. Ann Ophthalmol 1974;6:837–840.
Nasr A: Eyelid complications in trachoma. I. Cicatricial entropion. Ophthalmic Surg 1989;20:800–807.
Tiffany JM: The role of meibomian secretion in the tears. Trans Ophthalmol Soc UK 1985;104:396–401.
Tabbara KF, Bobb AA: Lacrimal system complications in trachoma. Ophthalmology 1980;87:298–301.
Laouissi N, Rais L, Zemiati S, Elbelhadji M, Alibou F: Isolated and primary palpebroconjunctival amylosis: Apropos of 2 cases. J Fr Ophtalmol 1998;21:152–155.
Hill VE, Brownstein S, Jordan DR: Ptosis secondary to amyloidosis of the tarsal conjunctiva and tarsus. Am J Ophthalmol 1997;123:852–854.
Jain NS, Gupta AN: Amyloidosis of conjunctiva. Br J Ophthalmol 1966;50:102–124.
Gupta VP, Aggarwal R, Aggarwal S: Conjunctival amyloidosis: Is it related to trachoma? Acta Ophthalmol 1993;71:839–840.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.