This document provides information about trachoma including its definition, epidemiology, etiology, risk factors, clinical presentation, diagnosis, treatment and prevention. Trachoma is caused by Chlamydia trachomatis and is the world's leading infectious cause of blindness. It is endemic in poor, rural areas with lack of water and sanitation. Clinical stages include active trachoma and scarring trachoma which can lead to trichiasis and corneal opacity. Treatment involves antibiotics and surgery. Prevention focuses on hygiene, sanitation and the SAFE strategy promoted by WHO to eliminate trachoma by 2020.

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

2. CONTENT
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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.tracho
matis
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.

11. Risk Factors for Trachoma
• Environmental 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

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

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

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

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

18. 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

19. 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).

20. 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.

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

22. 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

24. 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.

26. 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.

28. 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.

30. 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.

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

33. 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.

34. TI Vs ALLERGIC CONJ.

35. 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.

36. TREATMENT OF TRACHOMA

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

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

39. Do antibiotics improve all grades of
trachoma?

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

41. • 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.

42. 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.

43. 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.

44. BILAMELLAR TARSAL ROTATION
 Patient who has severe eyelid scarring causing the eyelid to
turn inward (entropion) with many eyelashes 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.

45. Can we improve vision after corneal scarring?

46.  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.

47. • 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.

48. PREVENTION OF TRACHOMA

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

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

51. Cont’d
5-Community Health education

52. 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:
- Surgery for in-turned eyelashes,
-Antibiotics for active disease,

53. Cont’d
• Face washing (or promotion of facial cleanliness),
and
Environmental improvement to reduce
transmission

54. THANK YOU