A taste of clinics in Swaziland...

Just a few photos from the clinics:

Child with congenital glaucoma and buphthalmos ("ox eye") of the right eye. In children with raised intraocular pressure, their eyes can get very large.

Mother of the child with aniridia. She came in for an exam this week and it was incredibly how strikingly similar their exams were! Genetics is fascinating!

 

Child with aniridia that was seen last week.
 

Squamous cell carcinoma in a person who is HIV positive.

This is the third recurrence (s/p excision with mitomycin C and cautery x 2). It appears that the patient may now have scleral invasion, which is not a good sign. No enlarged lymph nodes were appreciated on exam. This is a "6/6" eye (our equivalent of 20/20 in the metric system), and this patient will likely need an enucleation (removal of eye), to stop the spread. Squamous cell carcinoma tends to travel along nerves ("perineural invasion") which can make it quite aggressive. It is quite common in the HIV positive population. Squamous cell carcinoma in the United States is often seen in quite elderly people who have a long history of significant sun exposure. We often see it in very young people here (20s, 30s), secondary to their HIV+ status/immunocompromise.

Same patient, both eyes.

 

Patient who is in mid-thirties who is HIV positive and has residual scarring after herpes zoster ("shingles") in the V1 distribution. He also had involvement of the left eye (herpes zoster ophthalmicus). This photo does a great job of illustrating that herpes zoster follows a dermatomal distribution and does not cross midline. He had full ocular motility, but did have resultant ptosis (droopy eyelid) on the left.

 

Patient with vernal keratoconjunctivitis or "warm weather conjunctivitis". Vernal keratoconjunctivitis is incredibly common amongst children in Swaziland, and it has periodic seasonal incidence (summer). On exam, the patient had Horner Trantas dots (not easily seen in this photo). She also had large papillae on her superior tarsal conjunctiva, bilaterally. The most notable feature here is the pannus/anterior stromal scarring of the inferior cornea. If not treated, this would continue to encroach on her central cornea, eventually involving her visual axis.