Trachoma is a chronic eye infection caused by Chlamydia trachomatis that often leads to blindness. It spreads easily in dry, dusty areas with poor sanitation and is the world's leading cause of infectious blindness. The infection causes eyelid changes and scarring that can result in trichiasis, where eyelashes turn inward and scratch the cornea. Treatment involves antibiotics and improving hygiene and sanitation to prevent spread. The WHO's SAFE strategy aims to eliminate trachoma blindness worldwide by 2020 through surgery, antibiotics, facial cleanliness, and environmental improvement.

2.  Definition
 Aetiology
 Clinical Features
 Sequelae
 Grading
 Management

3.  Trachoma is the commonest infective cause
of blindness in the world(15-20%)
 Trachoma is spread worldwide but highly
prevalent in North Africa, Middle East and
certain Regions of South-East Asia.

4.  A chronic inflammation of the conjunctiva
and the cornea, characterised by the presence
of follicles and papillary hypertrophy of the
conjunctiva, and by growth of blood vessels
over the cornea.
 Greek word for ’rough’

5.  Causative agent: Chlamydia trachomatis
 Any age
 Dry, dirty and sandy weather
 Poor, unhygienic conditions
 “Eye-seeking” flies
 Use of kajal or surma from the same
container

7.  Foreign body sensation or grittiness
 Itching
 Watering, photophobia and redness
 Discharge is usually scanty, but may be more
due to secondary infections
 Acute Trachoma- Secondary infection
superimposed on a relatively mild trachoma

8.  Bulbar congestion
 Velvety papillary hypertrophy
 Follicles-mostly seen in upper tarsal
conjunctiva or on the limbus or on the bulbar
conjunctiva
 Pannus: A Characteristic sign defined as fine
sub-epithelial neovascularisation, arranged
vertically with round cell infiltration, mainly
seen at the upper limbus and cornea

9.  Follicles (aggregation of lymphocytes and
other cells in the adenoid layer) are most
commonly seen in the upper tarsal
conjunctiva and fornix.

10. Progressive Pannus Regressive Pannus
 Infiltration of cornea is
ahead of vessels
 Vessels extend beyond
the area of infiltration

11. Oval or circular pitted scars in the area of
limbus, left after healing of herbert’s follicles.

12. 1. Mac Callan’s classification
2. Jone’s classification
3. WHO classification

13. Type Impression Diagnostic feature
TF Follicles Active disease -needs
treatment
5 or more follicles of at
least 0.5mm diameter
on the upper tarsal plate
TI Intense Severe Disease- Urgent
treatment
Pronounced
inflammatory thickening
which obscures more
than half of the normal
deep tarsal vessels
TS Scarring Old, inactive infection Tarsal conjunctival
scarring seen as white
fibrous bands
TT Trichiasis Needs corrective surgery Presence of at least one
trichiatic eye lash
CO Opacities Corneal opacities from
previous trachoma cause
visual loss
Presence of corneal
opacity over the pupil

15. Each case must have at least two of the
following signs
1. Follicles at the upper tarsal conjunctiva
2. Limbal Follicles or their sequelae, Herbert’s
pits
3. Typical conjunctival Scar (stellate shaped)
4. Vascular Pannus, mostly at the upper limbus

16. 1. Eyelids
◦ Ptosis
◦ Entropion and trichiasis
◦ Tylosis (rounding of the lid borders)
◦ Madarosis (loss of eyelashes)
◦ Ankyloblepheron (adhesions B/W upper & lower lid
margin)
2. Conjunctiva
◦ Loss of Fornices
◦ Parenchymatous xerosis
◦ Concretions (whitish deposits)
◦ Pseudo-pterygium
◦ Symblepheron

17. 3. Cornea
◦ Herbert’s pits
◦ Healed pannus leading to hazy cornea
◦ Loss of sensation
◦ Total corneal pannus (blinding)
4. Lacrimal sac
◦ Chronic dacryocystitis

18. 1. Therapeutic
a) Topical- Tetracycline (1%) eye ointment Or
sulphacetamide(20% or 30%) eye drops- 4 times a
day for 6 weeks
b) Systemic-Tetracycline or erythromycin 250mg
orally, four times daily for 3-4 weeks Or
Doxycycline 100mg orally twice daily for 3-4
weeks Or oral Azithromycin 250mg once daily for
4 days

19. 2. Prophylactic
◦ Improvement of personal hygiene, and
environmental sanitaion
◦ The use of common towel, handkerchief, surma
rods should be discouraged
◦ Early treatment of conjunctivits
◦ Blanket antibiotic therapy ( in Endemic areas)-
Intermittent treatment with tetracycline 1% eye
ointment twice daily for 5 consecutive days in a
month for 6 months

20. 3. Treatment of complications
◦ Trichiasis- epilation, electrolysis or cryolysis
◦ Entropion – surgical correction
◦ Follicles - mechanically expressed by Roller
forceps, silver nitrate painting or diathermy
◦ Concretions – removed with a hypodermic needle
◦ Pannus- Cryoapplication or peritomy
◦ Xerosis – treated by artificial tears

21.  An Effective intervention aiming at total
elimination of blindness due to trachoma by
the year 2020