Trachoma
Issrafil Mussa
Objectives
Definition of trachoma
Burden of trachoma
Risk factors and mode
of transmission
Pathogenesis
Signs and symptoms
Intervention and prevention
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SPHMMC, Department of Ophthalmology
Outline
• Introduction
• Epidemiology
• Risk factors and transmission
• Pathogenesis
• Signs and symptoms , WHO grading
• Diagnoses
• Management-SAFE strategy
• Prevention
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Introduction
● Infectious disease of the eye caused by
bacterium called Chlamydia
trachomatis(repeated infection)
● Most common infectious cause of blindness in the
world(leading preventable cause of blindness
worldwide)
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Trachoma
Epidemiology
● Endemic to more than 50 countries(WHO)
● 500 million people at risk of blindness from the
disease(CDC)
● 21 million people are living with active trachoma and
another 1.9 million people are blind or severely visually
impaired.
● 7.3 million people suffer from trichiasis and are at risk for
developing blindness.
● It causes about 1.4% of all blindness worldwide. 6
Epidemiology
● Active trachoma is most common in young children
with the prevalence of active trachoma decreasing
with age.
● More predominant in females than males
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Pathogenesis
● Repeated infection of conjunctival epithelium –subsequent
inflammatory response-tissue destruction
○ Fibrosis and contraction
○ cicatrial enteropion with triachiasis and lash
corneal touch
○ Corneal erosion, ulceration, scaring and
vascularization-
○ Opacification and blindness
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Risk factors
6D’s
• Dry(Inadequate water supply)
• Dusty(poor environmental hygiene)
• Dirty(Poor facial hygiene)
• Dung(faeces, children)
• Discharge (secretions around the eye)
• Density(crowd life style, sleeping with a patient)
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Transmission
5F’s
• Fingers
• Flies
• Face
• Faeces
• Fomites( objects like dishes contaminated with
infectious agents)
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symptoms
• Mild itching and irritation of the eyes and
eyelids
• Eye discharge containing mucus or pus
• Eyelid swelling
• Light sensitivity (photophobia)
• Eye pain
• Eye redness
• Vision loss 11
Clinical findings
• Active:
• Follicular Conjunctivitis: yellow-white elevations on the
upper eyelid.
• Conjunctival congestion
• 'Herbert's pits -depressions on the upper margin of the
cornea left by large conjunctival follicles.
• pathognomonic for trachoma.
• Papillary Hypertrophy
• Corneal Pannus: vascularization of the upper cornea 13
Herbert’s pit’s
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Corneal Pannus
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Repeated Infection(cicatricial):
• Conjunctival Scarring: White bands that represent
fibrosis
• Cicatricial Entropion and Trichiasis: Fibrotic scar tissue
contraction causes the eyelid margin and eyelashes
turning inward and lashes touching the ocular surface -
Opacification cornea and conjunctiva.
• Corneal opacification and vascularisation: secondary to
repeat corneal irritation from inturned eyelashes 16
Entropion and trichiasis
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WHO grading
Trachomatous Follicular 5 or more follicles (>0.5 mm) in the
Inflammation (TF) upper tarsal conjunctiva
Inflammatory thickening of the tarsal
Trachomatous intensive Inflammati
on conjunctiva that obscures more than
(TI) half of the deep normal vessels
Trachomatous Scarring (TS) scarring in the tarsal conjunctiva
Trachomatous Trichiasis (TT) At least one lash rubs on the eyeball
Easily visible corneal opacity over
Corneal Opacity 18
the pupil
Intense inflammation
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Conjunctival scaring
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opacification
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Mc callans classification
Stage 1 Stage 2 Stage 3 Stage 4
(incipient (Established (cicatrizing ) (Healed
trachoma) trachoma) trachoma)A
Hyperaemia Appearance Scaring of Cured / not
Of palpebral of palpebral mark able
conjunctiva Mature conjunctiva
follicle and
papillae
Immature Progressive Scars easily Sequelae to
follicles corneal visible as cicatrisation
pannus white bands cause
symptoms
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Complications
●Scarring of the inner eyelid
●Eyelid deformities-entropion, trichiasis
● Corneal scarring or cloudiness
●Partial or complete vision loss
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Diagnosis
● Clinical diagnoses
● Follicles on the upper tarsal conjunctiva
● Limbal follicles and the sequelae(herbet
pits)
● Typical tarsal conjunctival scaring
● Vascular pannus most common on the
superior limbus
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DDX
● Allergic conjunctivitis
● Bacterial conjunctivitis
● Viral conjunctivitis
● Inclusion conjunctivitis
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Management
Management
• SAFE-strategy
• Surgery- correction of entropion, trichiasis,
• Antibiotic-new/recent infection(tetracycline,
azithromycin)
• Facial cleanliness-to prevent disease transmission
• Environmental improvement –to increase access
to water and sanitation, prevention 27
Prevention
● Good personal hygiene and environmental
sanitation
● Public health education
● Clean water supply for washing
● Flies control- insecticide, appropriate garbage
disposal
● Prevention of recurrent infection
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References
● Kanski’s clinical ophthalmology, 9th ed
● WHO:https://www.who.int/news-room/fact-sheets/detail/
trachoma
● CDC:https://www.cdc.gov/healthywater/hygiene/disease/
trachoma.html
● Eyewiki:file:///D:/Trachoma%20-%20EyeWiki.html
● Mayo clinic file:///D:/Trachoma%20-%20Symptoms%20and
%20causes%20-%20Mayo%20Clinic.html
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