Short Quiz on TRACHOMA
Instruction
2. There is 1 Mark for each correct Answer
Which of the following is not a sequelae of trachoma?
Proptosis REF: Khurana 4th ed p. 66
Sequelae of trachoma:
- Lids : entropion, tylosis, ptosis, madarosis , ankyloblepharon
- Conjuctiva: concretions, pseudocyst, xerosis, symblepharon.
- Cornea: opacity, ectasia, xerosis.
- Others: Dacrocystitis, chronic dacryoadenitis.
To establish the presence of endemic trachoma in a family or community, a substantial number of children must have at least two of the following signs:
- Five or more follicles on the flat palpebral conjunctiva lining the upper eye lid.
- Typical conjunctival scarring of the upper palpebral conjunctiva.
- Limbal follicles or their sequelae (Herbert’s pits).
- An even extension of blood vessels on to the cornea, most marked at the upper limbus.
All of the following statements about Chlamydia trachomatis are true except –
Ans. is ‘d’ i.e., Penicillin is the treatment of choice
. Doxycyline is the DOC for chlamydial infections. Erythromycin is DOC in pregnant women.
. Genital chlamydial infections are often totally asymptomatic
. Chlamydia trachomatis can be isolated ( cultured) into embryonated eggs, experimental animals, tissue cultures.
. Inclusion conjuctivitis is caused by serotypes D-K.
Ans. is ‘b’ i.e., Is an intracellular organism
Chlamydia trachomatis infection commonly causes –
Ans. is ‘a’ i.e., Infertility
“Infertility associated with fallopian tube scarring has been strongly linked to antecedent C. trachomatis infection in serological studies.”
Seen in trachoma are/is:
A i.e. Papillary hypertrophy; B i.e. Follicles; C i.e. Panus formation
Which of the following is/are caused by trachoma:
A. i.e. Entropion
Trachoma is characterized by A/E:
D i.e. Ectropion of upper eyelid
Sequelae of trachoina is entropion (not ectropion)Q, corneal opacity and Xerosis (dryness)(2)
Trachoma/ Egyptian Opthalmia
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Epidemiology |
Clinical Features |
Sequelae & Complication |
Diagnosis |
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• Etiological agent |
• Incubation pd. is 1-3 weeks |
• Sequelae are changes |
• Clinically, at least two of |
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is chlamydia trachomatis |
• Sequelae occurs at least after 20 years, so peak incidence of blinding is in 4th– |
occurring as a part of the natural history of |
these sign should be present to establish the diagnosis |
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serotype A, B, Ba, |
5th decade |
disease |
i) Presence of follicles more |
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CQ (a Bedsonian – |
• Symptoms- |
– Lids: tylosis |
in the upper than lower |
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PLT organism) |
– In absence of secondary infection |
(thickening of lid |
palpebral conjuctiva |
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• 1/5th of world |
symptoms are minimal & include mild |
margin), Trichiasis |
ii) Epithelial keratitis in the |
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population is |
foreign body sensation |
(inward misdirection |
early stages most marked in |
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affected |
– In presence of 2° infection typical |
of cilia), entropionQ |
upper part of cornea |
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• Predisposing |
symptoms of acute mucopurulent |
(inturning of the lid |
iii) Pannus in upper part of |
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factors |
conjunctivitis develop eg. lacrimation, |
margin), ptosis |
cornea |
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– Infancy & |
photophobia discharge etc |
(drooping of upper |
iv) Limbal follicles or their |
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childhood |
• SignsQ – |
eyelid), madarosis |
sequelae as Herbert pitsQ |
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– Females |
I. Conjuctival signs |
(absence of cilia), |
v) Stellate scarring in |
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– Dry & dusty |
– Congestion |
ankyloblepharon |
conjuctiva with linear |
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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 |
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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. |
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transmission by increasing |
in sulcus subtarsalis is called, Arlt’s linect |
(anterior staphyloma), total |
iii) Mc Coy cell culture, monoclonal antibody direct |
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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 |
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– 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 |
|
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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 |
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* SAFE strategy for trachomaQ is – Surgery for trichiasis, Antibiotics, Facial |
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cleanliness & Environmental improvement. |
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Treatment |
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• Oral tetracycline, doxycycline, azithromycin, clarithromycin, erythromycin, rifampicin & sulfonamides |
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• Oral tetracycline cannot be given to childrenyears, pregnantwomen or nursing mothers. |
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• Sulfonamides have high risk of stevens Johnson syndrome and erythema multiforme. |
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• Topical treatment with tetracycline or erythromycin or sulfacetamide (less preffered) is cheaper more effective and has no risk of systemic side effects. |
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C i.e. Tetracycline
Treatment of Trachoma
- Oral tetracycline, doxycycline, azithromycin, clarithromycin, erythromycin, rifampicin & sulfonamides
- Oral tetracycline cannot be given to children < 8 years, pregnant women 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.
Ans. All of the above
H.P. inclusion bodies in trachoma are seen to be:
Ans. Intracytoplasmic
- Trachoma (previously known as Egyptian ophthalmia) is a chronic keratoconjunctivitis, primarily affecting the superficial epithelium of conjunctiva and cornea simultaneously.
- It is characterised by a mixed follicular and papillary response of conjunctival tissue. It is still one of the leading causes of preventable blindness in the world.
- The word ‘trachoma’ comes from the Greek word for ‘rough’ which describes the surface appearance of the conjunctiva in chronic trachoma.
Etiology
- Causative organism: Trachoma is caused by a Bedsonian organism, the Chlamydia trachomatis belonging to the Psittacosis-lymphogranuloma trachoma (PLT) group.
- The organism is epitheliotropic and produces intracytoplasmic inclusion bodies called H.P. bodies (Halberstaedter Prowazeke bodies).
- Presently, 11 serotypes of chlamydia, (A, B, Ba, C, D, E, F, G, H, J and K) have been identified using microimmunofluorescence techniques.
- Serotypes A, B, Ba and C are associated with hyperendemic (blinding) trachoma, while serotypes D-K are associated with paratrachoma (oculogenital chlamydial disease).
Ans. Adenoid layer is devoid of lymphoid tissue
All of the following are corneal signs of trachoma except _____.
Arlt’s line is a conjunctival sign of trachoma.
Corneal signs of trachoma:
Superficial keratitis
Follicles in the limbal area
Pannus: superior limbus
Corneal ulcer
Herberts pits: near Limbal area
Corneal opacity
Conjunctival signs of trachoma:
Congestion: On upper tarsal, fornix
Follicles (containing Leber cells on histopathology): On upper tarsal, fornix
Papillary hyperplasia
Arlt’s line: Linear scarring in sulcus subtarsalis
Concretions: Inspissated mucus, dead epithelial cells in the glands of Henle
The mass treatment of trachoma is undertaken if the prevalence of severe or moderate trachoma, in children under 10 years, is more than:
September 2012
Ans: C i.e. 5%
A prevalence of more than 5% severe and moderate trachoma in children tinder 10 years of age is an indication for mass/ blanket treatment.
Trachoma can cause all of the following except:
March 2005
Ans. D: Enopthalmos
Complications of trachoma include:
- Inward-turning eyelashes (trichiasis)
- Cloudiness of the cornea (pannus)
- Drooping eyelids (ptosis)
- Ulceration of the cornea
- Progressive scarring of the cornea that can result in blindness.
September 2008
Ans. C: Surgery
- Antibiotics to treat infection in individuals.
- Facial cleanliness to reduce transmission of trachoma.
- Environmental improvement through increased access to clean water and improved sanitation.
Ans. A i.e. Infertility
Chlamydia infections — even those that produce no signs or symptoms — can cause scarring and obstruction in the fallopian tubes, which might make women infertile.
Cause of blindness in trachoma ‑
Ans. is ‘a’ i.e., Scarring
The later structural changes of trachoma are referred to as “cicatricial trachoma”.
These include scarring in the eyelid (tarsal conjunctiva) that leads to distortion of the eyelid with buckling of the lid (tarsus) so that eye lashes rub on the eye (trichiasis).
Rubbing of eye lashes of scarred eye lids against the cornea leads to corneal opacities and scarring and then to blindness.
Thus actual cause of blindness is corneal opacity and scarring, which may be secondary to eyelid scarring.
Ans. b. 1-9 years
Cicatrising trachoma is seen in ‑
Ans. is ‘c’ i.e., Stage-3
- McCal Ian’s classification-McCallan in 1908 divided the clinical course of trachoma into 4 stages
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Stage 1 (Incipient trachoma) Hyperaemia of palpebral |
Stage 2 (Established tracoma) | Stage 3 (Cicatrising trachoma) | Stage 4 (Healed trachoma) |
|
Immature follicle |
Appearance of mature follicle & conjunctiva papillae | Scarring of palpebralconjunctiva | Disease is cured or is not
markable |
| Mild superfecial punctate keratopathy | Progressive corneal pannus | Scars are easily visibleas white bands Necrosis | Sequelae to cicatrisationcause symptoms |
- Stage 2 is further subdivided into :-
- 2a (Ha) :- Presence of mature follicles
- b (Hb) :- Marked papillary hyperplasia
