TRACHOMA
Introduction
• Trachoma is a chronic keratoconjunctivitis caused by [Link]
serovars A,B,Ba,C primarily affecting the superficial epithelium of
conjunctiva and cornea simultaneously.
• It is characterized by a mixed follicular and papillary response of
conjunctival tissue.
Global scenario
• Public health problem in 41 countries of Africa, Central and South
America, Asia, Australia and the Middle East
•Responsible for the irreversible blindness or visual impairment of
about 1.9 million people
• Causes about 1.4% of all blindness worldwide
• Economic cost from blindness and visual impairment is US$ 2.9-5.3
billion annually, increasing to US$ 8 billion when trichiasis is included
Agent factors
• Classical endemic trachoma - Chlamydia trachomatis of immune types A, B, or C
• Sexually transmitted - Chlamydia trachomatis serotypes D,E,FG,H,I,J,OR K
- may also infect eyes –Inclusion conjunctivitis
- Rarely produce permanent visual loss.
- May cause respiratory infections in infant
• Other pathogenic organisms
-Morax Axenfeld diplobacillus - most innocous.
-Koch-Weeks bacillus - most widespread.
-Gonococcus- most dangerous
Host factors
• AGE
-children of 2-5 years are most infected
-Endemic areas children show signs at age of only a few months
• SEX
-prevalence equal in younger age groups
-In older age groups - female affected more
• Pre-disposing factors-direct sunlight, dust, smoke, irritants like kajal
or surma
Environmental factors
• SEASON- Seasonal epidemics are associated with vastly eye seeking
flies
• QUALITY OF LIFE-trachoma is associated with poor quality of life. The
disease thrives in conditions of poverty, crowding, poor personal
hygiene, poor housing
• CUSTOMS- The custom of applying kajal or surma to the eyes is a
positive risk factor
Mc Callans classification
• STAGE 1- incipient trachoma/ stage of [Link] of
palpebral conjunctiva & immature follicles
• STAGE 2- stage of florid infiltrationmature follicles, papillae,
progressive pannus
• STAGE 3- cicatarizing trachoma/ stage of scarring
• STAGE 4- healed trachoma/ stage of sequale
Clinical features
• Incubation period- 5 to 21 days
• Onset –subacute, but on massive outbreaks can be acute
• Symptoms watering, fb sensation, redness, mucopurulent discharge,
photophobia, blurring, mild pain
Diagnosis
Requires at least 2 of the following clinical features:
• follicles on the upper tarsal conjunctiva
• limbal follicles and their sequelae (Herbert pits)
• typical tarsal conjunctival scarring
• vascular pannus most marked on the superior limbus
Follicles
Herbetr pits
Trichiasis
Conjunctival scarring
Pannus
Sequelae
• Lids- trichiasis, entropion, tylois, ptosis, madarosis
• Conjunctiva- concretions, pseudocyst, xerosis, symblepharon
• Cornea - opacity, ectasia, xerosis, total corneal pannus( blinding
sequale)
• Punctal stenosis, fibrosis of canaliculi
Elements of control
• Assessment of problem
• Chemotherapy
- Mass treatment
- Selective treatment
• Surgical correction
• Surveillance
• Health educationEvaluation
Need Of assessment of problem
Primary objective of programme for trachoma control is prevention of
blindness
• Focus on communities with high prevalence of blinding trachoma
indicated by
Corneal blindness
Trachomatous trichiasis and entropion
Moderate and severe Trachomatous inflammation
• Such communities have blindness rates of >0.5%
• Also required - information on local conditions and existingresources
Chemotherapy
• Objective - reduce severity, lower incidence and thence prevalence in
long run
• Antibiotic of choice - 1% ophthalmic ointment or oily suspension of
tetracyclines
• Erythromycin and Rifampicin also used
• Treatment can be Mass or Selective
Chemotherapy
Mass treatment
- Blanket treatment
- Prevalence of moderate or severe trachoma is >5% in children
under 10 years
- Application of 1% tetracycline ointment to all children
• Twice daily for 5 days each month for 6 consecutive months, or
• Once daily for 10 days each month for 6 consecutive months-
Erythromycin is alternative antibiotic
Chemotherapy
• Selective treatment
-In communities with low to medium prevalence
- Whole population at risk is screened
- Treatment is applied only to those with active problem
- Principles of treatment remaining same
Surgical correction
Tha nk you
