The document discusses the anatomy, structure, blood supply, lymphatic drainage, and clinical features of conjunctivitis. Some key points:
- The conjunctiva lines the eyelids and eyeball and contains epithelium, an adenoid layer, and a fibrous layer. It has different structures in different regions.
- Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis. It presents with follicles, papillae, pannus, scarring, and can lead to entropion and trichiasis.
- Clinical features of conjunctivitis include redness, discharge, follicles, membranes, and papillae
these slide are modified or upgraded from the slid belonging to this website.i had added some of the content.hope that it will be more helpful to you all.
these slide are modified or upgraded from the slid belonging to this website.i had added some of the content.hope that it will be more helpful to you all.
EMBRYOLOGY
ANATOMY
BONY ORBIT
WALLS OF ORBIT
MUSCLES OF THE ORBIT
NERVE SUPPLY OF THE ORBIT
VASCULAR SUPPLY
LACRIMAL SYSTEM
ORBITAL FAT
ORBITAL INJURIES AND INFECTION
DENTAL SIGNIFICANCE
UVEA constitutes- middle vascular coat
• 3 parts- a)iris
b)ciliary body
c)choroid
• Developmentally,structurally and functionallyindivisible
• color varies from light blue to dark brown
EMBRYOLOGY
IRIS-
• Both layers of epithelium derived from
marginal region of optic cup (neuroectoderm)
• Sphincter and dilator pupillae- anterior
epithelium (neuroectoderm)
• Stroma and vessels- vascular mesoderm
Main physiologic function of cornea is to act as a major refracting medium, so that a clear retinal image is formed. • Normal corneal transparency is result of • 1.anatomical factor such as uniform and regular arrangement of corneal epithelium, peculiar arrangement of corneal lamella and corneal vascularity 2.Physiological factor [ie] relative state of corneal dehydration.
3. • Therefore, any process which upsets the anatomy or physiology of cornea will cause LOSS OF TRANSPARENCY to some degree.
4. FACTORS AFFECTING CORNEAL TRANSPARENCY • CORNEAL EPITHELIUM &TEAR FLIM • ARRANGEMENT OF STROMAL LAMELLA • CORNEAL VASCULARIZATION • CORNEAL HYDRATION • CELLULAR FACTORS AFFECTING TRANSPARENCY
Each eyelid contains a fibrous plate, called a tarsus, that gives it structure and shape; muscles, which move the eyelids; and meibomian (or tarsal) glands, which secrete lubricating fluids. The lids are covered with skin, lined with mucous membrane, and bordered with a fringe of hairs, the eyelashes.
This lecture includes anatomy, Physiology of eyelids, if u like it kindly share it with colleagues and like it. I will share more lectures related to eye anatomy and optometry.
Thank You.
EMBRYOLOGY
ANATOMY
BONY ORBIT
WALLS OF ORBIT
MUSCLES OF THE ORBIT
NERVE SUPPLY OF THE ORBIT
VASCULAR SUPPLY
LACRIMAL SYSTEM
ORBITAL FAT
ORBITAL INJURIES AND INFECTION
DENTAL SIGNIFICANCE
UVEA constitutes- middle vascular coat
• 3 parts- a)iris
b)ciliary body
c)choroid
• Developmentally,structurally and functionallyindivisible
• color varies from light blue to dark brown
EMBRYOLOGY
IRIS-
• Both layers of epithelium derived from
marginal region of optic cup (neuroectoderm)
• Sphincter and dilator pupillae- anterior
epithelium (neuroectoderm)
• Stroma and vessels- vascular mesoderm
Main physiologic function of cornea is to act as a major refracting medium, so that a clear retinal image is formed. • Normal corneal transparency is result of • 1.anatomical factor such as uniform and regular arrangement of corneal epithelium, peculiar arrangement of corneal lamella and corneal vascularity 2.Physiological factor [ie] relative state of corneal dehydration.
3. • Therefore, any process which upsets the anatomy or physiology of cornea will cause LOSS OF TRANSPARENCY to some degree.
4. FACTORS AFFECTING CORNEAL TRANSPARENCY • CORNEAL EPITHELIUM &TEAR FLIM • ARRANGEMENT OF STROMAL LAMELLA • CORNEAL VASCULARIZATION • CORNEAL HYDRATION • CELLULAR FACTORS AFFECTING TRANSPARENCY
Each eyelid contains a fibrous plate, called a tarsus, that gives it structure and shape; muscles, which move the eyelids; and meibomian (or tarsal) glands, which secrete lubricating fluids. The lids are covered with skin, lined with mucous membrane, and bordered with a fringe of hairs, the eyelashes.
This lecture includes anatomy, Physiology of eyelids, if u like it kindly share it with colleagues and like it. I will share more lectures related to eye anatomy and optometry.
Thank You.
CONJUNCTIVA: ANATOMY , PHYSIOLOGY, SYMPTOMATOLOGY AND CLASSIFICATION Pranay Shinde DNB Resident Deen Dayal Upadhyay Hospital,New Delhi
2. ANATOMY It is the mucous membrane covering the under surface of the lids and anterior part of the eyeball upto the cornea.
3. Parts of conjunctiva • Palpebral; covering the lids—firmly adherent. • Forniceal; covering the fornices—loose—thrown into folds. • Bulbar; covering the eyeball—loosely attached except at limbus.
4. Palpebral conjunctiva • Subtarsal sulcus 2mm from posterior edge of the lid margin. • Richly vascular. • Extremely thin. • Strongly bound to the tarsal plate.
5. Palpebral conjunctiva is subdivided into three parts: 1)Marginal 2)Tarsal 3)Orbital
6. Conjunctival fornices • Transitional region between palpebral and bulbar conjunctivae. • Superior fornix 10 mm from limbus. • Inferior fornix 8 mm from limbus. • Lateral fornix 14mm from limbus. • Medially absent. • Ducts of lacrimal glands open into lateral part of superior fornix.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. ANATOMY
Conjunctiva is a translucent mucous
membrane which lines the posterior surface
of the eyelids and anterior aspect of the
eyeball.
It stretches from the lid margin to the limbus,
and encloses a complex space called
conjunctival sac which is open in front at the
palpebral fissure.
5. 1. Palpebral conjunctiva
i. Marginal conjunctiva -from
the lid margin to about 2 mm
on the back of lid up to sulcus
subtarsalis
ii. Tarsal conjunctiva -thin,
transparent and highly
vascular.
Upper-adherent to whole tarsal
plate
Lower-adherent only to half
width of tarsus
iii. Orbital part ,lies loose
between the tarsal plate and
fornix.
6. 2 . Bulbar conjunctiva
• Thin, transparent
• Separated from the anterior
sclera by episcleral tissue
and Tenon's capsule-scleral
conjunctiva.
• 3 mm ridge around the
cornea is called limbal
conjunctiva.
3. Conjuctival fornix
• Joins the bulbar conjunctiva
with the palpebral
conjunctiva.
• Subdivided into superior,
inferior, medial and lateral
8. I. Epithelium
-2-5 layered, non-keratinized epithelium
-contains goblet cells which constitute about 10% of epithelium.
-varies from region to region
• Marginal conjuctiva -5-layered non-keratinised stratified squamous
epithelium
• Tarsal conjunctiva- 2-layered epithelium : superficial layer of cylindrical
cells and a deep layer of flat cells
• Fornix and bulbar conjunctiva -3-layered epithelium
superficial layer-cylindricalcells
middle layer-polyhedral cells
deep layer-cuboidal cells
• Limbal conjunctiva -5 to 6 layered stratified squamous epithelium.
9. 2. Adenoid layer
-k/a Lymphoid layer
-Fine connective tissue reticulum containing lymphocytes
-Most developed in the fornices
-Develops after 3- 4 months of life.
Conjunctival inflammation in an infant does not produce follicular
reaction.
3. Fibrous layer
-Network of collagenous and elastic fibres
-Thicker than adenoid layer, except at tarsal conjunctiva
-Contains vessels and nerves of conjunctiva
12. Blood supply of conjunctiva
Arteries supplying the conjunctiva are derived
from 3 sources
(1) peripheral arterial arcade of the eyelid
(2) marginal arcade of the eyelid
(3) anterior ciliary arteries.
Palpebral conjunctiva and fornices -peripheral
and marginal arterial arcades of the eyelids.
Bulbar conjunctiva is supplied by two sets of
vessels:
• Posterior conjunctival arteries
• Anterior conjunctival arteries
Terminal branches of the posterior conjunctiva!
arteries anastomose with the anterior conjunctival
arteries to form the pericorneal plexus.
13.
14.
15. Lymphatic drainage
Lymphatics of the conjunctiva are arranged in two layers: a superficial
and a deep.
Lymphatics from the lateral side drain into preauricularlymph nodes
Lymphatics from the medial side drain into submandibular lymph nodes.
FROM
LATERAL
SIDE
FROM
MEDIAL
SIDE
PREAURICULAR
LYMPHNODE
SUBMANDIBULAR
LYMPHNODE
16. NERVE SUPPLY
A circumcorneal zone of conjunctiva is
supplied by the branches from long ciliary
nerves which supply the cornea.
Rest of the conjunctiva is supplied by the
branches from
-Lacrimal
-Infratrochlear
-Supratrochlear
-Supraorbital
-Frontal nerve
17.
18. C/F OF CONJUNCTIVAL
INFLAMMATION
SYMPTOMS
-Lacrimation
-Grittiness
-Discharge
-Itching (hallmark of allergic disease)
-Pain/photophobia/foreign body sensation s/o
corneal involvement
19. DISCHARGE
Watery (serous)-clear fluid like serum-
viral,allergic conjunctivitis
Mucoid -chronic allergic conjunctivitis and dry
eye
Mucopurulent -chlamydial or acute bacterial
infection
Purulent -gonococcal infection
24. 5.)MEMBRANES
PSEUDOMEMBRANE TRUE MEMBRANE
Involves coagulated exudates
adherent to inflamed epithelium
Involves inflammatory exudates
interdigitated with superficial layer
inflamed conjunctival epithelium
Can be peeled away easily leaving
underlying epithelium intact without
bleeding
Removal leads to tearing and bleeding
EKC,Allergic conjunctivitis,Bacterial
conjunctivitis
N.gonorrhoea,C.diphtheria,SJS
25. 6.)INFILTRATION-celluar recruitment to the
site of chronic inflammation,accompanies
papillary response
Loss of detail of normal tarsal conjunctival
vessels,on upper lid
7.)SUBCONJUNCTIVAL
CICATRIZATION(scarring)-
Loss of goblet cells and accessory lacrimal
glands
Cicatricial entropion
Occur in trachoma,severe conjunctivitis
26. PAPILLAE FOLLICLES
LOCATION Palpebral conjunctiva
Limbal conjunctiva
Palpebral conjunctiva
(fornices)
SHAPE Polygonal with flat top Small oval with round top
HISTOLOGY Folds of hyperplastic
conjunctival epithelium
with fibrovascular core +
subepithelial stromal
infiltration of inflammatory
cells
Subepithelial germinal
centres + immature
lymphocytes at centre and
mature cells at periphery
SIZE Micropapillae-dot-like
Macropapillae- <1mm
Giant papillae >5mm
0.5-2mm
CAUSES Allergic,bacterial
conjunctivitis,blepharitis,su
perior limbic
Viral ,chlamydial
conjunctivitis,trachoma,toxi
n
28. CHLAMYDIAL
CONJUNCTIVITIS
Like viruses they are obligate intracellular and
filterable
Like bacteria they contain both DNA and RNA,
divide by binary fission and are sensitive to
antibiotics.
Combinedly form the PLT group (Psittacosis,
Lymphogranuloma venereum andTrachomatis
group).
29.
30. TRACHOMA
The word 'trachoma' (Greek word)stands for
'rough' which describes the surface appearance
of the conjunctiva in chronic trachoma.
A type of chronic keratoconjunctivitis, primarily
affecting the superficial epithelium of conjunctiva
and cornea simultaneously.
31. A. Causative organism: Chlamydia trachomatis
The organism is epitheliotropic and produces
intracytoplasmic inclusion bodies called H.P.
bodies (Halberstaedter Prowazeke bodies).
11 serotypes of chlamydia
Microimmunofluorescence techniques
B. Predisposing factors.
1. Age. 3. Race (Jews). 5. Socioeconomic status.
2. Sex. 4. Climate. 6. Environmental factors
32. C. Source of infection: Conjunctival discharge of
the affected person
D. Modes of infection:
1. Direct spread (Air, Water)
2. Vector transmission (Flies)
3. Material transfer (Towel, handkerchief, surma
rods)
33. Clinical profile of trachoma
Incubation period of trachoma varies from 5-
22 days. Onset of disease is usually insidious
(subacute),
however, rarely it may present in acute form.
In the absence of Secondary infection, a pure
trachoma is
mild and symptomless.
But, mostly the picture is complicated by
secondary infection
In the early stages it is clinically indistinguishable
from the
bacterial conjunctivitis and the term 'trachoma
34. A. Conjunctival signs
1. Congestion of upper tarsal and forniceal
conjunctiva.
2. Conjunctival follicles: Like boiled sagograins,
commonly on upper tarsal plate and fornix; but
may also be present in the lower fornix, plica
semilunaris and caruncle.
Sometimes, (follicles may be seen on the bulbar
conjunctiva (pathognomic of trachoma).
35.
36. Structure of follicle
Follicles are formed due to scattered aggregation
of lymphocytes and other cells in the adenoid
layer.
Central part of each follicle is made up of
mononuclear histiocytes, few lymphocytes and
large multinucleated cells called Leber cells.
37. The cortical part is made up of a zone of
lymphocytes showing active proliferation.
Blood vessels are present in the most peripheral
part. In later stages signs of necrosis are also
seen.
Presence of Leber cells and signs of necrosis
differentiate trachoma follicles from follicles of
other forms of follicular conjunctivitis.
38. 3. Papillary hyperplasia. Papillae are reddish, flat
topped raised areas which give red and velvety
appearance to the tarsal conjunctiva.
Each papilla consists of central core of numerous
dilated blood vessels surrounded by lymphocytes
and covered by hypertrophic epithelium.
39. 4.Conjunctival scarring which may be irregular,
star-shaped or linear.
Linear scar present in the sulcus subtarsalis is
called Arlt's line.
5. Concretions may be formed due to
accumulation of dead epithelial cells and
inspissated mucus in the depressions called
glands of Henle.
40. B. Corneal signs
1. Superficial keratitis may be present in the upper part.
2. Herbert follicles refer to typical follicles present
in the limbal area.
These are histologically similar to conjunctival follicles.
3. Pannus i.e., infiltration of the cornea associated
with vascularization is seen in upper part
In progressive pannus, infiltration of cornea is ahead of
vascularization.
In regressive pannus (pannus siccus) vessels extend a
short distance beyond the area of infiltration.
41.
42. 4. Corneal ulcer may sometime develop at the
advancing edge of pannus.
5. Herbert pits are the oval or circular pitted scars,
left after healing of Herbert follicles in the limbal
area.
6. Corneal opacity may be present in the upper
part.
43. McCallan's classification
Stage I (Incipient trachoma or stage of
infiltration).
It is characterized by hyperaemia of palpebral
conjunctiva and immature follicles.
Stage II (Established trachoma or stage of florid
infiltration). It is characterized by appearance of
mature follicles, papillae and progressive corneal
pannus.
44. Stage III (Cicatrising trachoma or stage of
scarring). It includes obvious scarring of palpebral
conjunctiva.
Stage IV (Healed trachoma or stage of
sequelae).
The disease is quite and cured but sequelae due
to cicatrisation give rise to symptoms.
45. WHO classification 1987
(FISTO):
1. TF: Trachomatous inflammation-follicular:
At least five or more follicles (each 0.5 mm or
more in diameter) must be present on the upper
tarsal conjunctiva.
Further, the deep tarsal vessels should be visible
through the follicles and papillae.
46. 2. TI : Trachomatous inflammation intense:
Pronounced
inflammatory thickening of the upper tarsal
conjunctiva obscures more than half of the
normal deep tarsal vessels.
47. 3. TS: Trachomatous scarring. This stage is
diagnosed by the presence of scarring in the
tarsal conjunctiva
48. 4. TT: Trachomatous trichiasis. TT is labelled
when at least one eyelash rubs the eyeball.
49. 5. CO: Corneal opacity: easily visible corneal
opacity is present over the pupil.
50. Sequelae of trachoma
1. Sequelae in the lids - trichiasis, entropion, tylosis
(thickening of lid margin), ptosis, madarosis and
ankyloblepharon.
2. Conjunctival sequelae -concretions, pseudocyst,
xerosis and symblepharon.
3. Corneal sequelae may be corneal opacity,
ectasia,
corneal xerosis and total corneal pannus (blinding
sequelae).
4. Other sequelae -chronic dacryocystitis , chronic
dacryoadenitis
51. Diagnosis
A. The clinical diagnosis of trachoma is made
from its typical signs; at least two sets of signs
should be present out of the following:
1. Conjunctival follicles and papillae
2. Pannus progressive or regressive
3. Epithelial keratitis near superior limbus
4. Signs of cicatrisation or its sequelae
52. B. Laboratory diagnosis.
1. Conjunctival cytology. Giemsa stained smears
showing a predominantly polymorphonuclear
reaction with presence of plasma cells and Leber
cells is suggestive of trachoma.
2. Detection of inclusion bodies in conjunctival
smear may be possible by Giemsa stain, iodine
stain or immunofluorescent staining, specially in
cases with active trachoma.
53. 3. Enzyme-linked immunosorbent assay (ELISA)
for
chlamydial antigens.
4. Polymerase chain reaction (PCR) is also
useful.
5. Isolation of chlamydia is possible by yolk-sac
inoculation method and tissue culture technique.
Standard single-passage McCoy cell culture
requires at least 3 days.
54. 6. Serotyping of TRIC agents is done by detecting
specific antibodies using
microimmunofluorescence
(micro-IF) method.
Direct monoclonal fluorescent antibody
microscopy of
conjunctival smear is rapid and inexpensive.
55. Differential diagnosis
1. Trachoma with follicular hypertrophy must be
differentiated from acute adenoviral follicular
conjunctivitis (epidemic keratoconjunctivitis).
2. Trachoma with predominant papillary
hypertrophy needs to be differentiated from
palpebral form of spring catarrh
56. Management
A. Treatment of active trachoma
1. Topical therapy regimes
1 percent tetracycline or 1 percent erythromycin
eye ointment 4 times a day for 6 weeks or 20
percent sulfacetamide eye drops three times a
day along with 1 percent tetracycline eye
ointment at bed time for 6 weeks.
The continuous treatment for active trachoma
should be followed by an intermittent treatment
especially in endemic or hyperendemic area.
57. 2. Systemic therapy regimes. Tetracycline or
erythromycin 250 mg orally, four times a day for 3-4
weeks
or
doxycycline 100 mg orally twice daily for 3-4 weeks
or single dose of 1 gm azithromycin has also been
reported to be equally effective in treating
trachoma.
58. B. Treatment of trachoma sequelae
C. Prophylaxis
1. Hygienic measures.
2. Early treatment of conjunctivitis.
3. Blanket antibiotic therapy (intermittent
treatment). In endemic areas to minimise the
intensity and severity of disease.
1 percent tetracycline eye ointment twice daily
for 5 days in a month for 6 months.