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TRACHOMA

By: Sumayya NaseemInternee Optometrist

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What is trachoma?

• Trachoma (Ancient Greek: "rough eye")

• Trachoma is the leading infectious cause of blindness worldwide. In the poorest countries in Africa, prevalence among children can reach 40 percent. The World Health Organization (WHO) estimates that 8 million people worldwide have been visually impaired by trachoma.

• Trachoma is a preventable cause of blindness and, if treated early, the prognosis for people with trachoma is excellent.

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Causes• Trachoma is caused by the bacterium

Chlamydia trachomatis And it is spread by: • Direct contact with eye discharge• Fomites such as towels and/or cloths• Poor personal and family hygiene. • Lack of water• Absence of latrines or toilets• Poverty in general• Flies• Close proximity to cattle• Crowding

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5 F’s & 5 D’s

5 F’s 5 D’s

Flies Discharge(eyes)

Filth(dirt, waste)

Dust

Faeces(human)

Dryness

Fingers Dung(animals)

Fomites(handkerchief, pillow)

Density (over crowding)

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Symptoms

• Mild itching and irritation of the eye

• Watering • Mucopurulent Discharge from the eye

As the disease progresses, later trachoma symptoms include:

• Marked light sensitivity (photophobia)

• Blurred vision

• Eye pain

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Signs

Conjunctiva:

• Follicular conjunctivitis (tarsal conj, fornices)

• Conjunctival scarring• Limbal follicles• Herbert's pits (after resolution of follicles)

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Normal Tarsal Conjunctiva

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Follicular Conjunctivitis

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Trachomatous Inflammation

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Conjunctival Scarring

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Herbert’s Pits

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Cornea:

• Keratitis (corneal ulcer)

• Corneal opacity (end stage)

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Corneal Opacity

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Lids: • Entropion• Trichiasis

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Trichiasis

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Entropion

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WHO Grading (FISTO)

• TF trachomatous follicles (5 sub tarsus)• TI trachomatous inflammation (50%

tarsal vessels covered)• TS trachomatous scarring• TT trachomatous trichiasis• CO corneal opacity

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Clockwise from top left: follicles of trachoma (TF), intense inflammation of trachoma (TI), trichiasis of trachoma (TT), Conjunctival scarring of trachoma (TS)

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Complications

• Scarring of the inner eyelid • Entropion• Trichiasis• Corneal scarring or cloudiness • Partial or complete vision loss

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Treatment

• Tetracycline, topical (2 months) and oral (3 weeks)

• Oral azithromycin

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Prevention

Proper hygiene practices, which include:

• Face washing. (especially children's)• Controlling flies. • Proper waste management. • Properly disposing animal and human waste

can eliminate breeding grounds for flies. • Improved access to water.• Improved sanitation and living conditions.

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SAFE Strategy

• Surgery for correction of trichiasis• Antibiotics• Face cleaning• Environmental improvement

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Some Important Terms• Follicles: These are enlarged nodules of lymphoid tissue under

the Conjunctival epithelium (fornix & tarsal conj.).

• Herbert’s Pits: Follicles may occur at limbus, become scarred and

shrink to form little pits. These are called Herbert's pits.

• Entropion: Severe scarring of the tarsal conjunctiva distorts the

eyelid, So, the margin of the eyelid turns inwards against the eyeball. This is called entropion.

• Trichiasis: Misdirected eyelashes (inward turned)

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