2. Introduction
Trachoma is a Greek word means “rough eye”
Globally, 41 million people suffer from active infection
It is caused by Chlamydia trachomatis.
This disease was the main reason that led to vision loss
in our country
3. Diagnosis
Diagnosis of this disease requires :
1. History
2. Clinical picture
3. Laboratory tests
4. Differential diagnosis
4. History
The patient may report
contact with an infected individual
Complain of ocular irritation and discharge.
Advanced cases: pain and foreign body
sensation may be reported.
Some report Diminution of vision.
6. Symptoms
Initial:
• Mild irritation of the eyes
• Watery discharge from the eyes.
Symptoms caused by repeated infection:
• blurred vision
• eye pain
• severe photophobia (sensitivity to light)
As the trachoma progresses to its final stage:
• Loss of some, and then all, vision occurs.
21. Pathognomic signs
the diagnosis of trachoma is likely to be correct if at
least two of the following criteria are present:
• Follicles on the upper palpebral conjunctiva in the mid-
tarsal region
• Linear scars of the tarsal conjunctiva (Arlt’s syndrome)
• Active keratitis
• Follicles in the limbus or their sequelae (Herbert’s pits)
• Pannus in the upper third of the cornea.
25. Differential Diagnosis
Condition Differentiating signs/symptoms Differentiating tests
Chlamuydia
Inclusion
Conjunctivitis
Generally occurs in adults not living in areas
where trachoma is endemic.
Swab culture detects
genital strains of
Chlamydia trachomatis.
Viral
conjunctivitis
A common cause of conjunctival follicle.It
can be distinguished from trachoma by an
acute history and mucopurulent discharge.
Herbert pits or pannus are absent.
Both conditions may lead to tarsal
conjunctival scarring.
A swab for HSV and
adenovirus could be
considered.
Bacterial
Conjunctivitis
Bacterial infection, such as Moraxella can be
a rare cause of follicle formation.
Absence of Herbert pits
Microscopy, culture and
sensitivity testing on a
conjunctival swab may
reveal a bacterial cause.
26. Condition Differentiating symptom / Sign Differentiating test
Idiopathic
trichiasis
May be difficult to differentiate clinically
from trichiasis due to trachoma, although it
is unlikely to have tarsal scarring.
Absence of Herbert pits.
Trachoma is more likely in an area where it
is endemic
Differentiated clinically.
Trichiasis due
to other
chronic
inflammatory
conditions
Trichiasis can be idiopathic or secondary to
a large range of chronic inflammatory
diseases such as blepharitis and chronic
conjunctivitis.
Absence of Herbert pits.
Trachoma is more likely in an area where it
is endemic
No differentiating tests
performed.
Corneal
opacity due to
other causes
There are many other causes of corneal
opacity.
However, when seen in conjunction with
trichiasis and other signs of trachoma in a
patient who has spent a significant amount
of their life in a trachoma-endemic area, a
diagnosis of trachomatous corneal opacity is
likely.
No differentiating tests
performed.
27. Complications
1. Lid complications (more in the upper lid):
• Trichiasis (usually multiple).
• Cicatricial entropion.
• Mechanical ptosis due to Heaviness of eye lid
• Chronic Meibomianitis.
28. 2. conjunctival complications:
• Posterior symblepharon (shallow fornix)
• It may obliterate ducts of the main lacrimal gland
leading to loss of reflex lacrimation.
• Xerosis due to atrophy of goblet cells.
30. 4. Lacrimal complications:
• Epiphora due to fibrosis of lacrimal puncti or
canaliculi.
• Dacryocystitis (chronic) due to fibrosis of
nasolacrimal duct.
• Dacryoadenitis.
31. Treatment
Prophylactic treatment
• This disease persists in communities without
adequate access to water and sanitation.
• The WHO recommended the “ S A F E ” strategy as
the trachoma control program, which includes
32. SAFE
• S urgery to correct advanced stages of the disease
• A ntibiotics to treat active infection
• F acial cleanliness to reduce disease transmission
• E nvironmental change to increase access to clean
water and improved sanitation.
33. Curative Treatment
Medical treatment
General treatment
Oral sulphonamides
To kill chlamydia trachomatis & to avoid 2ry infection
Dose: Sluphadiazine 1 gm tablet 3 times daily for 10 – 15 days
Side effects:
Allergy
Crystalline urea
Bone marrow depression
Oral systemic antibiotic
If the patient is sensitive to sulphonamides
Examples: Azithromycin, Erythromycin
& Tetracycline, doxycycline (for adults only)
34. Local treatment
Local broad spectrum antibiotic
Terramycin ointment (1 %) 3 times daily for 2 months
Sulphacetamide drops (10-30 %) 6 times daily for 2 months
Atropin ointment If the cornea is involved
35. Surgical Treatment
Expression of follicles
In typical follicular trachoma (T-ll, A)
By ripe by Grady’s forceps.
Scraping of papillae
In papillary trachoma (T-ll, B)
By sharp spoon
Picking of PTDs & PTCs
In projecting PTDs & PTCs (T-lll & T-lV)
By Beer’s knife with a pointed blade
36. Treatment of complications
Complication of Eye lid:
Pure trichiasis
For upper lid we do van Millngen operation
For lower lid we do Webster operation.
Cicatricle entropion
For upper lid we do snellen's operation.
For lower lid we do Webster's operation.
37. Mechanical ptosis
Due to increase the weight by papillae and
Just remove the papillae.
Multiple chalizia
Due to fibrosis of Miebomian gland duct
We give Antibiotic to prevent 2ry bacterial infection
Plus steroids to decrease inflammation and fibrosis.
38. Complication of Lacrimal system:
Spread of infection
Chronic dacryoadenitis
Chronic dacryocystitis
Epiphora
Overcome the obstruction of the pathway surgically
Usually the puncti are the site of fibrosis (do 2 or 3 snip operation)
39. Complication of conjunctiva:
Posterior symblypharon
Synechotomy surgery to cut the adhesion
Mucous membrane graft to cover opposite surfaces
Keratoplasty if the cornea is affected
Xerosis
Medical by:
Tear substitutes
Lacriset
Tear preservative
40. Complication of the cornea
Pannus
Thin pannus: Medical Treatment
Thick Pannus: Medical treatment & scraping by sharp spoon
Vascular Pannus: Medical treatment, periotomy & actual cautery of
blood vessles
Ulceration
Opacities
Keratectesia
41. Follow Up
• Long-term, intermittent follow-up care is required for
patients with active or cicatricial disease.
• Annual follow-up care Surgical patients require
because of the potential for recurrence
42. References
• Wikipedia.org
• E-medicine.medscape.com
• "Trachoma control: a guide for program managers."
World Health Organization”
• The Global Network for Neglected Tropical Diseases
• International Trachoma Initiative
• Reacher M, Foster A, Huber J.
• Wright HR, Turner A, Taylor HR
• C. Savona Ventura, University of Malta, 2003
• Gupta, UC and Preobragenski, W
