Short Quiz on TRACHOMA


1. This Test has 21 Questions 
2. There is 1 Mark for each correct Answer

MCQ – 1

Which of the following is not a sequelae of trachoma?



Explanation :

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.

MCQ – 2

Numerous cases of trachoma is reported in a period of time in a village. All of the following are the criteria to establish the presence of endemic trachoma in a community, EXCEPT:


Herbert’s pits

conjunctival scarring

vascular loops extending onto the cornea

Explanation :

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:

  1. Five or more follicles on the flat palpebral conjunctiva lining the upper eye lid.
  2. Typical conjunctival scarring of the upper palpebral conjunctiva.
  3. Limbal follicles or their sequelae (Herbert’s pits).
  4. An even extension of blood vessels on to the cornea, most marked at the upper limbus.
All of the signs of trachoma are more severe in the upper than in the lower conjunctiva and cornea.
Ref: Nijm L.M., Garcia-Ferrer F.J., Schwab I.R., Augsburger J.J., Corrêa Z.M. (2011). Chapter 5. Conjunctiva & Tears. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

MCQ – 3

Which of the following type of corneal degeneration is MOST commonly seen in patients with trachoma?

Terrien’s disease

Band keratopathy

Labrador keratopathy

Salzmann’s nodular degeneration

Explanation :
Patients with trachoma are prone to develop Salzmann’s nodular degeneration. This disorder is usually preceded by corneal inflammation particularly phlyctenular keratoconjunctivitis or trachoma.  Patients usually presents with redness, irritation, and blurring of vision. 
In this condition, there is degeneration of the superficial cornea that involves the stroma, Bowman’s layer, and epithelium, with superficial whitish-gray elevated nodules sometimes occurring in chains.
Labrador Keratopathy is thought to be caused by exposure to ultraviolet light and is characterized in the early stages by fine subepithelial yellow droplets in the peripheral cornea. 
Ref: Biswell R. (2011). Chapter 6. Cornea. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

MCQ – 4

All of the following statements about Chlamydia trachomatis are true except –

Genital chlamydial infections are often asymptomatic

Can be cultured

Inclusion conjuctivitis is caused by C. trachomatis serotypes D-K

Penicillin is the treatment of choice

Explanation :

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.

MCQ – 5

Chlamydia trachomatis true is –

Is a yeast

Is an intracellular organism

Forms extracellular bodies which are diagnostic

Is never demonstrable in conjuctival scrapping

Explanation :

Ans. is ‘b’ i.e., Is an intracellular organism 

MCQ – 6

Chlamydia trachomatis infection commonly causes –


Post coital bleeding



Explanation :

Ans. is ‘a’ i.e., Infertility 
“Infertility associated with fallopian tube scarring has been strongly linked to antecedent C. trachomatis infection in serological studies.” 

MCQ – 7

Seen in trachoma are/is:

Papillary hypertrophy


Panus formation


Explanation :

A i.e. Papillary hypertrophy; B i.e. Follicles; C i.e. Panus formation

MCQ – 8

Which of the following is/are caused by trachoma:





Explanation :

A. i.e. Entropion

MCQ – 9

Trachoma is characterized by A/E:

Epithelial Keratitis

Conjunctival follicles

Round pannus

Ectropion of upper eyelids

Explanation :

D i.e. Ectropion of upper eyelid

Sequelae of trachoina is entropion (not ectropion)Q, corneal opacity and Xerosis (dryness)(2)

Trachoma/ Egyptian Opthalmia 


Clinical Features

Sequelae &



•   Etiological agent

•   Incubation pd. is 1-3 weeks

•  Sequelae are changes

•  Clinically, at least two of

is chlamydia


•  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

serotype A, B, Ba,

5th decade


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

•   1/5th 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


–   In presence of 2° infection typical

of cilia), entropionQ

upper part of cornea

•   Predisposing

symptoms of acute mucopurulent

(inturning of the lid

iii) Pannus in upper part of


conjunctivitis develop eg. lacrimation,

margin), ptosis


– Infancy &

photophobia discharge etc

(drooping of upper

iv) Limbal follicles or their


•   SignsQ –

eyelid), madarosis

sequelae as Herbert pitsQ


I. Conjuctival signs

(absence of cilia),

v) Stellate scarring in

– Dry & dusty

– Congestion


conjuctiva with linear


– 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


differentiate it from spring catarrh.)


irradiated Mc Coy cells

•   Source of infection

Conjuctival folliclesQ : presence of

pseudocyst, xerosis


is discharge, so


leber cellsQ necrosis & size of >5 mm

differentiate trachoma follicles from



ii) Micro immunofluorescence

(micro-IF) testis

bacterial infections

help in


– Conjuctival scarring: linear scar present

Corneal: opacity Q,

xerosis, ectasia

recommended for routine

diagnostic use.

transmission by


in sulcus subtarsalis is called, Arlt’s



staphyloma), total

iii) Mc Coy cell culture,

monoclonal antibody direct

jcon     val ucti


•   Mode of infection

II. II Corneal C    Signs


–   Superficial keratitis

Herbert folliclesQ, which form pitted

corneal pannus (1/ t


– Lacrinal: chronic


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


–    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                                               ,


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


by immunofluor escent


v) Culture of C. trachomatis on

yolk sac

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


cleanliness & Environmental improvement.



•     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.

MCQ – 10

Drug of choice of trachoma is





Explanation :

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.

MCQ – 11

Trachoma inclusion bodies in conjunctival smear are detected by:

Giemsa stain

Iodine stain

Immunofluorescent staining

All of the above

Explanation :

Ans. All of the above

MCQ – 12

H.P. inclusion bodies in trachoma are seen to be:





Explanation :

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.


  • 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).

MCQ – 13

Trachoma in a newborn cannot produce follicular reaction because:

Antibodies are transfered from mother

Adenoid layer is devoid of lymphoid tissue

Immunity is not developed

Incubation period is one year

Explanation :

Ans. Adenoid layer is devoid of lymphoid tissue

MCQ – 14

 All of the following are corneal signs of trachoma except _____.

Herbert’s pits



Arlt’s line 

Explanation :

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

MCQ – 15

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





Explanation :

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.

MCQ – 16

Trachoma can cause all of the following except:
March 2005

Loss of vision

Clouding of the cornea



Explanation :

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.

MCQ – 17

“SAFE” strategy for control of trachoma; ‘S’-stands for:    
September 2008





Explanation :

Ans. C: Surgery

Surgery to correct advanced stages of the disease
  • Antibiotics to treat infection in individuals.
  • Facial cleanliness to reduce transmission of trachoma.
  • Environmental improvement through increased access to clean water and improved sanitation.

MCQ – 18

Chlamydia trachomatis infection commonly causes:


Post coital bleeding



Explanation :

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.

MCQ – 19

Cause of blindness in trachoma



Chronic dacrocystitis


Explanation :

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.

MCQ – 20

Screening are for trachoma is:

Below 5 years school child only

1-9 years

9-14 years

5-15 years

Explanation :

Ans. b. 1-9 years

MCQ – 21

Cicatrising trachoma is seen in ‑





Explanation :

Ans. is ‘c’ i.e., Stage-3 

  • McCal Ian’s classification-McCallan in 1908 divided the clinical course of trachoma into 4 stages

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


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

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