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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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