Trachoma

1. MEKELLE UNIVERSTY COLLEGE OF HEALTH SCIENCE AYDER REFERRAL HOSPITAL OPHALMOLOGY UNIT SEMINAR ON TRACHOMA PREPARED BY GIRMAWI.M

2. CONTENT Definition Epidemiology Etiology Risk factor Clinical presentation Diagnosis Treatment

3. TRACHOMA one of the major blinding diseases most common infectious cause of blindness.

4. EPIDEMILOGY The WHO estimates that 84 million people suffer from active trachoma and most of these are under 15 years of age. over 7 million have trichiasis (ingrown eyelashes Up to 1.3 million are thought to be blind due to the eye disease

5. CONT’D Endemic in 50 countries Confined to poor developing countries -Africa -Middle east -Asia -Latin America -Pacific Island

6. ETIOLOGY Trachoma is caused by the organism Chlamydia trachomatis which is a - highly infectious - subdivided into a number of serotype serotype( A,B,C) - associated with eye to eye infection serotype (D-K) - associated with genital tract infection and ophthalmic neonatrem(newborn conjunctivitis)

7. c.trachomatis inclusion bodies

8. TRANSMISION By direct contact with Eye secretion Nasal secretion Throat affected secretion By contact with fomites such as Hand kerchiefs Towels or wash cloths contaminated with these secretion Eye seeking flies

9. Episodes of infection usually begin in childhood, while blindness from corneal scarring occurs after repeated infection, untreated inflammation,scarring of the eyelids, distortion of the eyelashes, associated trauma and secondary bacterial infection .

10. Risk Factors for Trachoma E nvironmental factors - lacks effective sanitation, and adequate fresh water supplies -presence of animals kept near to dwellings and piles of animal dung provide breeding places for flies - Flies are attracted to red eyes with discharge, and carry the organism Chlamydia trachomatis to the eyes of others within a family or a community, both children and adults

11. Risk factor Dry Dusty Dirty Dung Discharge Density (overcrowding in the home

12. factors which influence transmission of infection -Flies -Faeces -Faces -Fingers -Fomites (contaminated material or objects such as clothing or towels)

13. CLINICAL MANIFESTATION The clinical manifestations of trachoma can be divided into two phases: 1- active trachoma and 2- cicatricial trachoma

14. ACTIVE TRACHOMA Active trachoma - mostly seen in young children -majority are asymptomatic -cause mild self limited follicular conjunctivitis - Mild irritation -Red eyes

15. CONT’D -Discharge - 2ry bacterial infection -Eyelid or Conjunctival edema -Pain and photophobia -Blurring of vision Physical finding of active trachoma is - follicle on upper tarsal conjunctiva

16. CIACATRICIAL DISEASE Commonly seen in adult Repeated episodes of infection cause marked conjunctival inflammation leading to eyelid scarring→Eyelid scar tissue eventually contracts distort the lid margin leading to entropion (inward rolling of the eyelid) and subsequent trichiasis (ingrown eyelashes).

17. CONT’D Eyelash abrasion on the cornea leads to corneal edema, ulceration and scarring. If untreated, corneal pannus (inflammatory vascular tissue) eventually develops followed by corneal opacification, and loss of vision.

18. WHO TRACHOMA GRADING SYSTEM TF- Trachomatous Inflammation – Follicular TI – Trachomatous Inflammation – Intense TS –Trachomatous Scarring TT – Trachomatous Trichiasis CO –Corneal Opacity

19. TF-FOLLICULAR Cxed by - presence of 5 or more follicle -each 0.5 mm in diameter -Rounded -Slightly raised -Usually paler than the remaining conjunctiva surface -on the flat surface of the upper tarsal conjunctiva - which are tiny accumulation of lymphoid cell

20. TI - INTENSE The tarsal conjunctiva -thickened and inflamed -diffuse inflammatory infiltration with edema and enlarged vascular papillae -more than one half of the deep conjunctival vessel must be covered with inflamed conjunctiva so that the blood vessel are no longer visible.

21. Trachomatous Scarring Presence of scarring and fibrosis in the tarsal conjunctiva. Appear as white lines. Common in the older pts. Causes distortion of the upper eyelid.

22. Trachomatous Trichiasis Trichiasis is defined as 1 or more eyelashes rubbing against the eyeball or evidence of lash removal. Common in women and starts at adolescence. Due to advanced conjunctival scarring and the distortion of the upper eyelid.

23. Corneal Opacity This is when the scarring is central and very dense enough to obscure part of the pupil margin. Usually after 20 yrs. Reduced vision. Much improvement is not expected even after treatment.

24. DDX Allergic conjunctivitis Bacterial conjunctivitis Neonatal conjunctivitis Viral conjunctivitis Trichiasis

25. Allergic conjunctivitis Usually Present in children and is a chronic condition Particularly common spring and summer - itching , red eyes, irritable -In the florid state, papillae appear on the tarsal conj. --- Cobblestone appearance. Thickening of tissue at the CSM helps distinguish it from trachoma.

26. TI Vs ALLERGIC CONJ.

27. Neonatal Chlamydia Conjunctivitis It is caused by Chlamydia trachomatis serovars D to K acquired from the mother during delivery. Presentation is 5-12 days postpartum with mucopurulent discharge , eyelid edema and papillae.

28. TREATMENT OF TRACHOMA

29. TREATMENT OF ACTIVE TRACHOMA The application of tetracycline 1 % eye ointment to both eyes two times each day for 6 weeks, or .

30. CONT’D 2. a single oral dose of 20mg azithromycin per kilogram of body weight, to a maximum of 1g

31. Do antibiotics improve all grades of trachoma?

32. CONT’D NO Azithromycin or tetracycline ointment are effective only against active trachoma, particularly follicular trachoma (TF) and intense inflammatory trachoma (TI).

33. Scarring of the eyelids causes the eyelashes to be distorted and these may constantly rub against the eyeball. When only one or two eyelashes are causing trouble, a simple temporary measure is to remove each eyelash using forceps.

34. CONT’D A little mirror or polished surface may help in the removal of irritating eyelashes. The eyelashes grow again in 4 to 6 weeks, the procedure has to be repeated when irritation recurs.

35. CONT’D A more permanent method of dealing with an isolated ingrowing eyelash is to apply electrolysis, after injecting local anesthetic into the eyelid at the base of the eyelash.

36. BILAMELLAR TARSAL ROTATION Patient who has severe eyelid scarring causing the eyelid to turn inward ( entropion ) with many eyelashe s rubbing on the cornea are treated with eyelid surgery called Bilamellar tarsal rotation. which is designed to rotate the eyelashes and give considerable relief to the patient .

37. Can we improve vision after corneal scarring?

38. If the cornea is considerably scarred, then it is seldom possible to improve the eyesight. Corneal grafting is not usually successful in these eyes. However , if there is an area of one cornea which does remains clear, where the scarring effects of trachoma involve the cornea in each eye, an optical iridectomy may be considered.

39. In this surgical procedure, the pupil of the eye is made bigger so that the patient can look through the widened pupil which has been surgically enlarged behind the clear area of cornea.

40. PREVENTION OF TRACHOMA

41. Personal and Community Hygiene Regular daily face-washing (and hand-washing). 2 . The basic need of a suitable water supply near at hand.

42. Cont’d 3. Ventilated pit latrines to improve community hygiene. 4. Animals, especially cattle, housed, if possible, some distance from the family home.

43. Cont’d 5-Community Health education

44. WHO launched Global Elimination of Trachoma 2020 (GET). The World Health Organization (WHO) is aiming to eliminate trachoma as a blinding disease by 2020. A useful strategy is the SAFE strategy : - S urgery for in-turned eyelashes, - A ntibiotics for active disease,

45. Cont’d F ace washing (or promotion of facial cleanliness), and E nvironmental improvement to reduce transmission

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