A 72-Year-Old Woman With Chronic Pain and Tearing

C. Robert Bernardino, MD


January 25, 2012

Clinical Presentation

A 72-year-old white woman presents with chronic pain and tearing in her left eye that started 3 months ago.

Her medical history is significant for recurrent oral ulcers. Her ocular history includes glaucoma in both eyes that is being managed with travoprost therapy. Brimonidine use was discontinued 6 months ago owing to a presumed allergic reaction.

Her ocular examination revealed visual acuity of 20/30 in the right eye and 20/50 in the left eye. Her pupils had no afferent pupillary defect. Motility was normal.

External examination revealed trichiasis, symblepharon, and entropion of the left lower eyelid (Figures 1-3). Slit-lamp examination showed 2+ injection of the inferior conjunctiva in both eyes.

Figure 1. External photograph of the patient showing bilateral chronic conjunctivitis and entropion of the left lower eyelid.

Figure 2. Chronic conjunctivitis of the right eye.

Figure 3. Chronic conjunctivitis of the left eye with symblepharon, causing entropion of the left lower eyelid.

Diagnostic Question

What is the differential diagnosis at this juncture?

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Diagnostic Question

What is the next step?

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