Formula Medical Group
Apple Valley, CA

James Krider, MD

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Granular eyelid - Trachoma

What is granular eyelid?

Granular eyelid, or trachoma, is a chronic type of conjunctivitis, an inflammation of the conjunctiva, which is a thin layer of moist tissue that lines the inside of the eyelid and covers the white portion of the eye. Unlike acute conjunctivitis, which affects only the conjunctiva, granular eyelid also involves the eyelids and cornea, a transparent membrane that arches over the colored part of the eye. Granular eyelid causes marked discomfort and abnormal cell proliferation. Without treatment, it scars the cornea and threatens vision.


  • Red, irritated eyes.
  • A gritty sensation, as if sand were in the eyes.
  • Swollen eyelids.
  • Sensitivity to light.
  • Tearing or discharge from the eyes.
  • Awakening with eyes stuck together due to discharge.
  • Eye pain.
  • Progressive grainy appearance in the conjunctiva of the upper eyelid.

Granular eyelid is also called granular conjunctivitis and Egyptian ophthalmia — the latter because the disease is common in the Middle East. It is, in general, more widespread among people living in poverty than in affluent societies. In the United States, it occurs mostly among Native Americans and residents of the rural South.

What causes granular eyelid?

The condition is caused by infection with Chlamydia trachomatis, a microscopic organism similar to bacteria. The strain of Chlamydia that causes granular eyelid is related to the strain responsible for parrot fever {psittacosis), an infectious disease carried by birds.

Trachoma is contagious; it may be spread either by direct contact or indirectly through washcloths, linens, or eye makeup previously used by an infected person. It is most common in areas of the world where personal hygiene is poor

A granular eyelid causes marked discomfort and, if untreated, it can threaten vision.

A granular eyelid causes marked discomfort and, if untreated, it can threaten vision.

How is granular eyelid diagnosed and treated?

A physician can usually diagnose granular eyelid after examining the eyes. Even so, blood tests and laboratory analysis of a sample of the eye discharge or some cells scraped from the eyelid should be performed.

Antibiotic eye ointment is the usual treatment for trachoma.

What can I do myself?
Self-treatment will not cure granular eyelid, but a person can take some simple measures to ease discomfort and prevent further infection.

Soothe itchy, burning eyes with warm, wet compresses, and avoid touching the eyes or using eye makeup. Use disposable tissues to wipe discharge from the eyes.

When should I see my doctor?
Any persistent eye redness, discomfort, pain, or sensitivity to light should be investigated by an ophthalmologist.

What will the doctor do?
After granular eyelid has been diagnosed, a doctor will prescribe an antibiotic ointment to be applied to the eyes 3 or 4 times a day for 4 to 6 weeks. In addition, oral antibiotics may be prescribed. Tetracycline and erythromycin usually are effective in combating infections caused by chlamydia.

Neglecting a case of granular eyelid for a long period can cause eyelid deformities which must be surgically repaired after the infection is cured.

The course of granular eyelid

Before symptoms appear, granular eyelid incubates for about 7 days after exposure to the infectious organism. The initial symptoms (swollen, red, irritated eyes with a discharge and sensitivity to bright light) usually prompt people to call a doctor.

However, if treatment does not begin at this stage or if the infection is resistant to treatment, small follicles develop in the conjunctiva of the upper eyelid about a "week later. In the ensuing weeks, these follicles slowly increase in size and number, leading to a granular appearance — hence the name granular eyelid. During this time, a rough, grainy membrane called a pannus may form over all or part of the cornea itself. The pannus may be filled with tiny blood vessels and form a mild to severe opacity over the cornea. In advanced cases, the conjunctiva, cornea, and colored part of the eye all have a grayish, opaque appearance.

Depending on when treatment begins and how well the patient responds, the pannus may remain the same size or continue to grow for several months to a year. If treatment is delayed too long, the pannus may never disappear completely. Inadequate treatment also leads to the formation of scar tissue, which may obstruct the tear duct and cause entropion (an inward turning of the eyelid), permanent corneal opacity, and vision loss.

Is granular eyelid dangerous?
Prompt antibiotic treatment usually cures granular eyelid. However, it is a major cause of blindness in North Africa and the Middle East.

What can I do to avoid granular eyelid?

  • Make sure hands are washed before touching the eyes.
  • Avoid using other people's washcloths and towels, especially for the face.
  • Do not share eye makeup or other facial cosmetics.

Closeup of eye following successful treatment.

Closeup of eye following successful treatment.
This article was last reviewed November 29, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
Chlamydia trachomatis

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