trachoma-paula.pptx

opthamology

1. TRACHOMA PAULINE TEMBO(RN,BSC)

2. Introduction Trachoma is an infectious eye disease caused by the bacterium Chlamydia trachomatis, which spreads by contact with an infected person’s hands or clothing. According to the 2016 Trachoma Mapping and Survey results-Zambia , trachoma is still prevalent in seven (7) Provinces, namely Southern, Western, Northern, Copperbelt, Muchinga , Luapula , and Central provinces. Most people who live in trachoma endemic areas and are at risk of trachoma blindness. Blindness from trachoma is irreversible

3. OBJECTIVES General Objective : At the end of the lecture/discussion, students should be able to gain knowledge on Trachoma. Specific Objectives : At the end of the lecture, students should be able to; Define Trachoma State atleast four (4) the predisposing factors Explain the mode of transmission Outline the WHO classification of Trachoma. State the signs and symptoms of trachoma. Explain the investigations done in the diagnosis of trachoma. Describe the management of Trachoma. State complications of Trachoma. Explain the preventive Measures of trachoma

4. DEF: Trachoma is a Chronic, bilateral scaring form of conjunctivitis caused by chlamydia trachomatis. It is highly contagious It leads to irreversible blindness

5. PREDISPOSING FACTORS Dust – associated with inadequate water supply. Dung- living with animals Dirty enviroment Discharge- poor facial hygiene. Overcrowding Not using water to maintain cleanliness. Sharing beddings and face cloths. Those that live near the rivers where fishing is the main occupation  

6. TRANSMISSION The following are the agents to the spread of trachoma: Fingers : eye to fingers then fingers to eyes. Flies: eye to flies then flies to eyes. Fomites : eyes to fingers then to fomites such as door handles. From handles to fingers and eventually the eyes or towels face to face. Families : it is between family members. The mothers, sisters and brothers. This is due to sharing of articles or utensils

7. STAGES OF TRACHOMA 1. TRACHOMATOUS INFLAMMATION FOLLICULAR : the first stage is the Presence of follicles. These are small bumps formed by swollen lymph tissue on the part of the upper eyelid and at times extending to the upper eyelid. The presence of 5 follicles of 0.5mm on the conjunctiva lining the back of the eyelid is what is called TF 2. TRACHOMATOUS INFLAMMATION INTENSE: the swelling of the conjunctiva 3 TRACHOMATOUS SCARING: bands of scar tissue form within the conjunctiva lining the inside of the eyelid

8. 4. TRACHOMATOUS TRICHIASIS : The bands of scar tissue tighten and causes the lid margins to turn inwards(entropion),this causes the eye lashes to rub against the conjunctiva. This leads to abrasions of the cornea. 5. CORNEAL OPACITY : coneal abrasions can lead to infectious ulcers and ultimately opaque scarring which blocks light from entering leading to blindness

9. WHO grading of trachoma Acronym - FISTO TF = trachomatous inflammation ( follicular ) : five or more follicles (>0.5 mm) on the superior tarsus TI = trachomatous inflammation ( intense ) :diffuse involvement of the tarsal conjunctiva, obscuring 50% or more of the normal deep tarsal vessels; papillae are present TS = trachomatous conjunctival scarring : easily visible fibrous white tarsal bands

10. CONT….. TT = trachomatous trichiasis: at least one lash touching the globe or resent evidence of eye lash epilation.   CO = corneal opacity sufficient to blur details of at least part of the pupillary margin.

11. Signs and symptoms Initially there’s; Red eye. Eye discharge Diffuse conjunctival inflammation After 2 – 3 weeks specific changes of active trachoma becomes apparent, these are; Follicles on the tarsal conjunctiva. Scarring on the tarsal conjunctiva Trichiasis Keratitis Corneal ulcer Corneal scar

12. Follicles under the eyelid

13. DIAGNOSIS Usually Diagnosis is based on clinical examination and history from the patient. Conjunctival scrapings for giemsa staining it will demonstrate trachoma inclusion bodies. Conjunctival swab for culture and sensitivity

14. management- SAFE” Strategy S: S urgery ( trichiasis surgery ) A: Antibiotics F: Facial cleanliness E: Environmental improvement “S” for surgery: is the most urgent of the four components of the SAFE strategy: individuals with TT are at imminent risk of loss of sight, and should be offered management as soon as possible. a corneal transplant is done to prevent sight loss. If the eyelid has rotated(entropion), tasal rotation can be done.

15. A” Antibiotics to reduce the level of Chlamydia trachomatis infection in the community. Treating infection in individuals with active trachoma and by reducing transmission of infection from person to person. Apply T.E.O 1% t.d.s for 6wks (TF/TI). Azythromycin 500- 1000mg PO OD once a day for 3 days and given once a year as prophylaxis

16. F ” is for face washing Educating community members and promoting facial and personal hygiene is vital in the elimination of trachoma vectors. Constant face washing with soap and water helps prevent the infection from inoculating the eyes.

17. ENVIROMENTAL CLEANLINESS Cleaning of the environment reduces flies. Burying of pits, clearing of animal waste reduces flies.

18. PREVENTION In preventing trachoma they use SAFE strategy. S – Surgery if there’s trichiasis. This prevents complications of blindness due to cornea scarring. A - Antibiotics supply in active trachoma (TF/TI) prevents further transmission of the infection. F – Facial cleanliness. Discharge is eliminated hence breaking the transmission. E – Environmental improvement. Helps in the elimination of the vectors.

19. Cont … Educate communities on good personal hygiene Exercise good waste disposal practices Education to community members not to share face towels and avoid communal hand towels Change pillow case often Do not touch eyes with dirty hands

20. COMPLICATIONS Corneal ulcer If trichiasis not corrected Scar formation if surgery is not done. Low vision due to corneal opacity Blindness due opacification of the cornea.