Trachoma

OPTHAL MBBS

1. Trachoma

2. Definition Aetiology Clinical Features Sequelae Grading Management Contents

3. 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

4. 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

5. 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 container Aetiology

6. Trachoma Blindness

7. 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

8. 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

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

10. Pannus Progressive Pannus Regressive Pannus Infiltration of cornea is ahead of vessels Vessels extend beyond the area of infiltration

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

12. Mac Callan’s classification Jone’s classification WHO classification Classifications of Trachoma

13. Type Impression Diagnostic feature TF F ollicles Active disease - needs treatment 5 or more follicles of at least 0.5mm diameter on the upper tarsal plate TI I ntense Severe Disease - Urgent treatment Pronounced inflammatory thickening which obscures more than half of the normal deep tarsal vessels TS S carring Old, inactive infection Tarsal conjunctival scarring seen as white fibrous bands TT T richiasis Needs corrective surgery Presence of at least one trichiatic eye lash CO O pacities Corneal opacities from previous trachoma cause visual loss Presence of corneal opacity over the pupil Who classification of trachoma(FISTO)

14. Each case must have at least two of the following signs Follicles at the upper tarsal conjunctiva Limbal Follicles or their sequelae , Herbert’s pits Typical conjunctival Scar ( stellate shaped) Vascular Pannus , mostly at the upper limbus Diagnostic criteria in field study

15. Eyelids Ptosis Entropion and trichiasis Tylosis (rounding of the lid borders) Madarosis (loss of eyelashes) Ankyloblepheron (adhesions B/W upper & lower lid margin) Conjunctiva Loss of Fornices Parenchymatous xerosis Concretions (whitish deposits) Pseudo- pterygium Symblepheron Sequelae of trachoma

16. Cornea Herbert’s pits Healed pannus leading to hazy cornea Loss of sensation Total corneal pannus (blinding) Lacrimal sac Chronic dacryocystitis Sequelae of trachoma (continued)

17. Therapeutic Topical- Tetracycline (1%) eye ointment Or sulphacetamide (20% or 30%) eye drops- 4 times a day for 6 weeks 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

18. 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)

19. 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)

20. An Effective intervention aiming at total elimination of blindness due to trachoma by the year 2020 SAFE strategy of WHO

21. Thank you