Trachoma

Epidemiology

Clinical Features

Sequelae &

Complication

Diagnosis

•   Etiological agent

•   Incubation pd. is 1-3 weeks

•  Sequelae are changes

•  Clinically, at least two of

is chlamydia

trachomatis

•  Sequelae occurs at least after 20 years,

so peak incidence of blinding is in 4^th–

occurring as a part of

the natural history of

these sign should be present

to establish the diagnosis

serotype A, B, Ba,

5th decade

disease

i)   Presence of follicles more

CQ (a Bedsonian –

•   Symptoms-

–   Lids: tylosis

in the upper than lower

PLT organism)

– In absence of secondary infection

(thickening of lid

palpebral conjuctiva

•   1/5^th of world

symptoms are minimal & include mild

margin), Trichiasis

ii) Epithelial keratitis in the

population is

foreign body sensation

(inward misdirection

early stages most marked in

affected

–   In presence of 2° infection typical

of cilia), entropion^Q

upper part of cornea

•   Predisposing

symptoms of acute mucopurulent

(inturning of the lid

iii) Pannus in upper part of

factors

conjunctivitis develop eg. lacrimation,

margin), ptosis

cornea

– Infancy &

photophobia discharge etc

(drooping of upper

iv) Limbal follicles or their

childhood

•   SignsQ –

eyelid), madarosis

sequelae as Herbert pitsQ

– Females

I. Conjuctival signs

(absence of cilia),

v) Stellate scarring in

– Dry & dusty

– Congestion

ankyloblepharon

conjuctiva with linear

weather

– Concretions

(adhesion between

conjuctival scarring of

– Low socio-

– Papillary hyperplasiaQ

margins of the upper

upper tarsus. (Ant’s line)Q

economic status

(Large size, typical cobble stone

and lower eyelids.

•   Laboratory diagnosis

– Unhygienic living

arrangement and acidic pH of tears

–   Conjuctival:

i)   Culture of c. trachomatis in

conditionsQ

differentiate it from spring catarrh.)

concretions,

irradiated Mc Coy cells

•   Source of infection

– Conjuctival folliclesQ : presence of

pseudocyst, xerosis

(expensive)

is discharge, so

superimposed

leber cellsQ necrosis & size of >5 mm

differentiate trachoma follicles from

(dryness)Q,

symblepharon

ii) Micro immunofluorescence

(micro-IF) testis

bacterial infections

help in

others.

– Conjuctival scarring: linear scar present

– Corneal: opacity Q,

xerosis, ectasia

recommended for routine

diagnostic use.

transmission by

increasing

in sulcus subtarsalis is called, Arlt’s

linect

(anterior

staphyloma), total

iii) Mc Coy cell culture,

monoclonal antibody direct

jcon     val ucti

secretion

•   Mode of infection

II. II Corneal C    Signs

Sig

–   Superficial keratitis

– Herbert folliclesQ, which form pitted

corneal pannus (1/ t

blindness)

– Lacrinal: chronic

dacryoadenitis,

tests and IgA-IPA light

microscopy tests form the

best combination of

diagnostic tools

– Vector

transmission by

flies (m.imp.l

scars after healing, known as Herbert

pitsQ

–    Pannus i.e. infiltration of cornea

chronic dacryocystitis

– Glucoma

iv) Cytology

–

Giemsa stained conjuctival

smears showing

– Material transfer

associated with vascularization

•• The only

predominantly polymorpho

eg. towel,

handkerchief etc.

between epithelium and Bowman’s                                               ,

membrane

complication of

trachoma is corneal

-nuclear reaction with

presence of plasma cells and

– Direct spread by

In progressive pannus, infiltration is

ulcerQ which may

Leber cells

air or water

ahead of vascularization

In regressive pannus (pannus siccus)

occur due to rubbing

of concretions or

–

Detection of inclusion body

vessels are ahead of infiltration

– Corneal ulcer and opacity may develop

at the advancing edge of pannus

trichiasis

by immunofluor escent

staining

v) Culture of C. trachomatis on

yolk sac

* SAFE strategy for trachomaQ is – Surgery for trichiasis, Antibiotics, Facial

cleanliness & Environmental improvement.

Treatment

•     Oral tetracycline, doxycycline, azithromycin, clarithromycin, erythromycin, rifampicin & sulfonamides

•     Oral tetracycline cannot be given to childrenyears, pregnantwomen or nursing mothers.

•     Sulfonamides have high risk of stevens Johnson syndrome and erythema multiforme.

•     Topical treatment with tetracycline or erythromycin or sulfacetamide (less preffered) is cheaper more effective

and has no risk of systemic side effects.

Stage 1 (Incipient trachoma) Hyperaemia of palpebral 

Immature follicle

markable