Trachoma

Definition Aetiology Clinical Features Sequelae Grading Management

Contents

Trachoma is the commonest infective cause of blindness in the world(15-20%)

Trachoma is spread worldwide but highly prevalent in North Africa, Middle East and certain Regions of South-East Asia.

Introduction

A chronic inflammation of the conjunctiva and the cornea, characterised by the presence of follicles and papillary hypertrophy of the conjunctiva, and by growth of blood vessels over the cornea.

Greek word for ’rough’

Definition

Causative agent: Chlamydia trachomatis Any age Dry, dirty and sandy weather Poor, unhygienic conditions “Eye-seeking” flies Use of kajal or surma from the same

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Aetiology

Trachoma Blindness

Foreign body sensation or grittiness Itching Watering, photophobia and redness Discharge is usually scanty, but may be

more due to secondary infections

Acute Trachoma- Secondary infection superimposed on a relatively mild trachoma

Symptoms

Bulbar congestion Velvety papillary hypertrophy Follicles-mostly seen in upper tarsal

conjunctiva or on the limbus or on the bulbar conjunctiva

Pannus: A Characteristic sign defined as fine sub-epithelial neovascularisation, arranged vertically with round cell infiltration, mainly seen at the upper limbus and cornea

Signs

Follicles (aggregation of lymphocytes and other cells in the adenoid layer) are most commonly seen in the upper tarsal conjunctiva and fornix.

Conjunctival Follicle

Pannus

Progressive Pannus Regressive Pannus

Infiltration of cornea is ahead of vessels

Vessels extend beyond the area of infiltration

Oval or circular pitted scars in the area of limbus, left after healing of herbert’s follicles.

Herbert’s Pit

1. Mac Callan’s classification2. Jone’s classification3. WHO classification

Classifications of Trachoma

Type Impression Diagnostic featureTF Follicles Active disease -needs

treatment5 or more follicles of at least 0.5mm diameter on the upper tarsal plate

TI Intense Severe Disease- Urgent treatment

Pronounced inflammatory thickening which obscures more than half of the normal deep tarsal vessels

TS Scarring Old, inactive infection Tarsal conjunctival scarring seen as white fibrous bands

TT Trichiasis Needs corrective surgery

Presence of at least one trichiatic eye lash

CO Opacities Corneal opacities from previous trachoma cause visual loss

Presence of corneal opacity over the pupil

Who classification of trachoma(FISTO)

Each case must have at least two of the following signs

1. Follicles at the upper tarsal conjunctiva2. Limbal Follicles or their sequelae,

Herbert’s pits3. Typical conjunctival Scar (stellate shaped)4. Vascular Pannus, mostly at the upper

limbus

Diagnostic criteria in field study

1. Eyelids◦ Ptosis◦ Entropion and trichiasis◦ Tylosis (rounding of the lid borders)◦ Madarosis (loss of eyelashes)◦ Ankyloblepheron (adhesions B/W upper & lower lid

margin)2. Conjunctiva

◦ Loss of Fornices◦ Parenchymatous xerosis◦ Concretions (whitish deposits)◦ Pseudo-pterygium◦ Symblepheron

Sequelae of trachoma

3. Cornea ◦ Herbert’s pits◦ Healed pannus leading to hazy cornea◦ Loss of sensation◦ Total corneal pannus (blinding)

4. Lacrimal sac◦ Chronic dacryocystitis

Sequelae of trachoma (continued)

1. Therapeutica) Topical- Tetracycline (1%) eye ointment Or

sulphacetamide(20% or 30%) eye drops- 4 times a day for 6 weeks

b) Systemic-Tetracycline or erythromycin 250mg orally, four times daily for 3-4 weeks Or Doxycycline 100mg orally twice daily for 3-4 weeks Or oral Azithromycin 250mg once daily for 4 days

Treatment

2. Prophylactic◦ Improvement of personal hygiene, and

environmental sanitaion◦ The use of common towel, handkerchief, surma

rods should be discouraged◦ Early treatment of conjunctivits◦ Blanket antibiotic therapy ( in Endemic areas)-

Intermittent treatment with tetracycline 1% eye ointment twice daily for 5 consecutive days in a month for 6 months

Treatment (continued)

3. Treatment of complications ◦ Trichiasis- epilation, electrolysis or cryolysis◦ Entropion – surgical correction ◦ Follicles - mechanically expressed by Roller

forceps, silver nitrate painting or diathermy◦ Concretions – removed with a hypodermic

needle◦ Pannus- Cryoapplication or peritomy◦ Xerosis – treated by artificial tears

Treatment (continued)

An Effective intervention aiming at total elimination of blindness due to trachoma by the year 2020

SAFE strategy of WHO

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