TRACHOMA

TRACHOMA

• Also c/d Egyptian ophthalmia.
• It is a chronic keratoconjunctivitis primarily affecting the superficial epithelium of conjunctiva & cornea simultaneously.
• Trachoma is characterized by mixed follicular & papillary conjunctivitis.
• Trachoma is caused by Chlamydia trachomatis serotypes A, B, Ba & C.
• The organism is epitheliotropic & produces intracytoplasmic inclusion bodies called HP bodies (Halberstaedterprowazeke bodies).

Clinical Features

A) Conjunctival signs

1. Congestion of upper tarsal & forniceal conjunctivva.

2. Conjunctival follicles:

• Boiled sagograin like follicles are commonly seen on upper tarsal coanjunctiva & fornix.
• Follicles are present on bulbar conjunctiva & presence of follicles on bulbar conjunctiva is pathognomic of trachoma.
• The characterstic feature of trachoma follicle is the presence of necrosis & leber cells (large multinucleated cells) which differentiates it from follicular conjunctivitis.

3. Papillary hyperplasia: Papillae are reddish, flat topped raised areas which give red & velvety appearance to the tarsal conjunctiva.

4. Conjunctival scarring: Linear scar present in the sulcus subtarsalis is called Arlt’s line.

5. Concretion: formed due to accumulation of dead epithelial cells & inspissated mucus in depressions called glands of Henle.

B) Corneal signs

1. Syperficial keratitis
2. Herbert follicles: Follicles in the limbal area
3. Pannus: Infiltration of cornea associated with vascularisation
4. Corneal ulcer: At the advancing edge of pannus.
5. Herbert pits: left after healing of Herbert follicles in the limbal area.
6. Corneal opacity

SEQUELAE & COMPLICATION OF TRACHOMA

1. Lids: Entropion, trichiasis, tylosis, ptosis
2. Conjunctival: Concretions, Xerosis (dryness)
3. Corneal: Corneal opacity, corneal ulcer
4. Other: Chronic dacryocystitis
5. Blindness 

McCALLAN’S CLASSIFICATION OF TROCHOMA

STAGE 1 (Incipient Trachoma)	STAGE 2 (Established Trachoma)	STAGE 3 (Cicatrising Trachoma)	STAGE 4 (Healed trachoma)
Hyperaemia of palpebral conjunctiva	Appearance of mature follicle & papillae	Scarring of palpebral Conjunctiva	Disease is cured or is not markable.
Immature follicle	Progressive corneal pannus	Scars are easily visible as white bands	Sequelae to cicatrisation cause symptoms
Mild superficial punctuate keratopathy		Necrosis

• STAGE 2 is further subdivided into:

1. 2a (II a): Presence of mature follicles
2. 2b(II b): Marked papillary hyperplasia 

WHO CLASSIFICATION

• Latest classification & has replaced all previous classification.

WHO CLASSIFICATION OF TRACHOMA	DIAGNOSIS
Trachomatous inflammation Follicular (TF)	At least 5 or more follicles of at least 0.5mm diameter on the upper tarsal conjunctiva.
Trachomatous inflammation Intense (TI)	Follicles & papillae are so numerous & inflamed that more than 50% of the palpebral conjunctival bv’s cannot be sseen clearly.
Trachomatous Scarring (TS)	This stage is diagnosed by the presence of scarring in the tarsal conjunctiva. These scars are easily visible white bands or sheets in the tarsal conjunctiva
Trachomatous Trichiasis (TT)	This is diagnosed when at least one eyelash rubs the eyeball. Evidence of recent removal of inturned eye lashes is also graded as trachomatous triachiasis.
Trachomatous Opacity (Corneal opacity=CO)	This stage is diagnosed when early visible corneal opacity is present over the pupil.

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