Site icon New

TRACHOMA

amit18289

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.

Exam Important

  • Cicatrising trachoma is seen in Stage-3.
  • Trachoma is characterized by Ectropion of upper eyelids.
  • Cause of blindness in trachoma is Conjunctival Scarring.
  • Single drug used for treatment of trachoma is Azithromycin.
  • Drug of choice for chylamydial trachomatis is Azithromycin.
  • Drug of choice of trachoma is Tetracycline.
  • Chlamydia trachomatis infection causes Pneumonitis, Conjunctivitis & Urethritis.
  • Chlamydia trachomatis infection commonly causes Infertility.
  • In the grading of trachoma, trachomatous inflammation-follicular is defined as the presence of 5 or more follicles in the upper tarsal conjunctiva.
  • Pathognomic features of trachoma follicle are Presence of Leber’s cells & Areas of necrosis.
Don’t Forget to Solve all the previous Year Question asked on TRACHOMA
Click Here to Start Quiz

Share this:

Exit mobile version