13.Trachoma p.pptx

causes of avoidable blindness, trachoma

1. Trachoma -It is a contagious disease caused by gram negative obligate intracellular bacteria chlamydia trachomatis serotypes A, B and C, Serotypes D-K are associated with genital infection. -Trachoma is a Greek word which means rough which describes the appearance of the surface of the conjunctiva.

2. Trachoma is the world’s leading cause of infectious blindness, an estimated 84 million people have active trachoma and 7.6 million have trachomatous trichiasis It is a disease of poor personal and community hygiene, affecting those living in the poorest condition, and disappears as living conditions improve. Repeated or persistent infection with the obligate intracellular bacteria Chlamydia trachomatis leads to a blinding syndrome (trachoma)

3. Trachoma progresses from inflammation of the upper tarsal conjunctiva to scarring; distortion of the eyelid causes trichiasis and eventual loss of vision secondary to corneal opacity after which blindness is essentially irreversible. Trachoma is common in the dry, hot, dusty climate which stretches from north India, Middle East, to North Africa and Sahel region of central and West Africa.

4. In Uganda it’s common in Kitgum , Kotido , Moroto , Nakapiripiti , Gulu , mansindi , Nebbi , Pader , Lira Busoga region, Tororo , Busia . Women and children 1-9yrs more affected Read about life cycle of chlamydia trachomatis

5. Pathophysiology Trachoma affects the epithelial cells of the conjunctiva and sub epithelium tissue. Re-infection is associated with severe inflammatory reactions resulting into sub epithelial fibrosis and scarring. Risk factors for trachoma -Lack of adequate water -House fly -Cattle -Poor personal hygiene -Overcrowding

6. Risk factors for transmission 5Fs Flies Feaces Fingers Fomites Faces 5Ds -Density /over crowding -Dusty -Dryness -Dung -Discharge

7. Clinical presentation Redness, eye discharge/ mucopurulent discharge, punctate keratitis Pannus Follicles 0.5-2mm/Papillae Herbert’s pits which are small dark dimples at the limbus , when limbal follicles resolve leave behind ghost pits Corneal scars Trichiasis Conjuctival scarring Floppy lid eyes/lid scarring Superficial punctate keratitis Watering due to lacrimal apparatus inflammation

8. WHO classification of trachoma Trachoma with follicles (TF) there must at least 5 follicles of 0.5mm-2mm on the upper tarsal plate but conjuctival vessels must be visible through the follicles Trachoma intense (TI) there are many follicles ,50% of the conjunctiva blood vessels cannot be seen. Trachomatous scarring (TS) white scars are present on the upper tarsal plate. Trachomatous trichiasis (TT) some eyelashes rubbing against the cornea Corneal opacities (CO) there are corneal opacities affecting the central cornea and lowering the vision to less than 6/18

9. SAFE strategy S urgery A ntibiotics -Mass treatment with antibiotics , -Azithromycin -Tetracycline eye ointment 4times for 3 weeks F ace washing E nvironmental sanitation -Pit latrine, and proper garbage dispose, Provision of adequate amount water  

10. Trachoma as public health problem TF (0-10YEARS OLD) >20% TI (0-10YEARS OLD) >5% TT (ADULT FEMALES) > 1% CO (ADULT FEMALES) <0. 1%