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If the parasites penetrate via the conjunctiva, there is unilateral redness and oedema of the upper and lower eyelids after 4 to 12 days. This is Romaña’s sign, named after the Argentinean physician Cecilio Romaña, who described the oedema in 1935. This swelling may last for weeks. Sometimes there is also swelling of the ipsilateral lymph nodes (including the pre-auricular lymph nodes). Trypanosomes may be found in the tears at this stage. If inoculation is in the skin there is local oedema and redness (chagoma) in 75% of cases. This remains for 1 to 4 months. From these sites the infections spreads. In the case of an infected blood transfusion, the incubation time may be 20 to 40 days.
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