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JAMA Ophthalmology Clinical Challenge
June 2018

Bilateral Cicatrizing Conjunctivitis in a Middle-aged Man

Author Affiliations
  • 1Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, Connecticut
  • 2Department of Pathology, Yale School of Medicine, New Haven, Connecticut
JAMA Ophthalmol. 2018;136(6):706-707. doi:10.1001/jamaophthalmol.2017.5490

A 53-year-old man presented with chronic ocular irritation that he attributed to his eyelashes, which he usually removed himself. His medical history was significant for hypertension and multiorgan sarcoid that was confirmed in his late 20s by a sinus biopsy demonstrating consistent pathologic findings. The patient reported wearing contact lenses daily. His best-corrected visual acuity was 20/25 OD and 20/30 OS. Results of his eye examination were notable for bilateral trichiasis of the lower eyelids with scarring of the inferior fornices and symplepharon (Figure 1), but there was no evidence of intraocular involvement of sarcoid. He denied any skin blisters, oral ulcers, difficulty swallowing, trauma, severe conjunctivitis, or seasonal allergies. He was taking 160 mg of valsartan and 10 mg of prednisone daily since 2006 and had recently started taking 20 mg of methotrexate sodium weekly. The patient had a history of parental smoke exposure as a child and a 20 pack-year personal smoking history. He worked with high-temperature coating on aircraft components and reported exposure to aluminum, nickel, and cobalt but denied exposure to beryllium. Epilation was performed during his visit.