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June 1991

Case of Chancre of the Conjunctiva

Arch Dermatol. 1991;127(6):810. doi:10.1001/archderm.1991.01680050054004

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Thomas L. R., aged 36 years, consulted me [Dr. J. A. Andrews] June 16th, 1884.

Abrasion situated in cul-de-sac of lower eyelid of right eye. Sore of a dusky red color, ovoid in shape, and three-eighths of an inch in its longest diameter. Pronounced injection of conjunctiva of lid, only slight injection of ocular conjunctiva below, near abrasion. The sore is raised above the surrounding conjunctiva and has a hard base. The appearance is not unlike that presented by an ulcer of a Meibomian gland, except that it is not connected with the cartilage of the lid and has an indurated base. The sore occasions no pain, but "the eye feels as if there were something in it."

About three weeks before coming to me, patient states that while at work in his shop a piece of iron-filing flew into his right eye. He saw the foreign body in a glass and tried to remove it with a corner of his handkerchief, but did not succeed, whereupon a fellow-workman volunteered to try to dislodge the foreign body with his tongue, a practice in vogue in a machine shop where he had formerly been employed. After several attempts with the tongue the foreign body was lost sight of.

The swelling in lid was first noticed two days before consulting me, and patient thought it had been occasioned by the foreign body. No induration of pre-auricular ganglia at this visit.

The appearance of the swelling, together with the induration and history of the case, excited the suspicion that the sore was a chancre. Patient was directed to wash the eye with a solution of boric acid, and the man who had removed the foreign body with his tongue was sent for. He came only two weeks later, when he showed unmistakable signs of secondary syphilis.

Patient was lost sight of for a while. When he came to me on August 12th, 1884, he presented a typical roseola. Later, general glandular enlargement, etc. Patient remained under observation for eighteen months, and was, when last seen, apparently in good health, without any signs of constitutional disease.

Dr. Taylor had seen four cases of this variety of primary lesion. The mode of origin—viz., the use of the tongue to remove a foreign body from the eye—was interesting. About three years ago in Russia there occurred a number of cases of syphilis in a small village. All of these were due to this practice of removing foreign substances from the eye.

J Cutan Genito-Urin Dis.

June 1891;9:217-218.

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