2. Introduction
Trachoma is a contagious bacterial infection of the outer eye caused by
chlamydia trachomatis. It is classified as neglected tropical disease.
The infection causes roughening and scarring of the inner surface of the
eyelids and erosion of the corneal surface, which eventually leads to
blindness.
Trachoma is one of the leading causes of blindness worldwide today. The
bacteria are transmitted via direct or indirect contact.
Contact with the affected person's eye or nose are the main ways the
infection is spread. Closed living spaces and poor sanitation increase the
spread of the disease.
3. Epidemiology
• Trachoma is considered to be the third leading cause of blindness
worldwide after cataract and glaucoma.
• Almost 8 million people are either blind or have severe visual
impairment due to trachoma, according to some estimates. Africa,
some regions of the Middle East, the Indian Subcontinent, Southeast
Asia, and South America show the highest prevalence today.
• North America and Europe showed a significant reduction in disease
prevalence due to general improvement in living standards rather than
specific interventions.
• Trachoma is a childhood disease, and pre-school children are most
commonly affected as compared to adults.
4. Cause of trachoma
The bacteria responsible for trachoma is chlamydia trachomatis
Is transmitted from infected to uninfected individuals in numerous ways:
• direct eye to eye spread during close contact,
• hand-eye contact,
• indirect spread on fomites,
• and transmission by eye-seeking flies.
Crowded living conditions play a major role in promoting the spread of
the disease. Trachoma is frequently found to cluster within endemic
regions.
5. Predisposing factors
• Common in endemic communities with poor hygiene
• Communities with lack of access to clean water
• Children between 3-6 years of age
• People living in predominantly dry areas
• Living conditions with poor sanitation
• Lack of regular face washing.
6. Pathophysiology
Chlamydia are acquired by direct contact with mucous membranes or abraded skin,
that is, by sexual contact or by direct inoculation into the eye in the case of trachoma
or neonatal conjunctivitis.
Two forms of the organism are needed for infection and disease to occur: the
infectious, extracellular form called an elementary body (EB) and the noninfectious
but metabolically active intracellular form called a reticulate body (RB).
Receptors for EBs are primarily restricted to non ciliated columnar, cuboidal, and
transitional epithelial cells, which are found on the mucous membranes of the
urethra, endocervix, endometrium, fallopian tubes, anorectum, respiratory tract, and
conjunctivae.
7. • Infection is initiated by attachment of EBs to the apical surfaces of epithelial cells
of the conjunctiva, respiratory, gastrointestinal, or urogenital tracts, followed by
entry by receptor-mediated endocytosis.
• The EBs quickly modify their early endosomal membrane to exit the endosomal
pathway, thereby avoiding fusion with lysosomes and traffic on microtubules to
the peri-Golgi region.
Infection of epithelial mucosal cells with C. trachomatis has been shown to
generate several cytokines, including interleukin-1α (IL-1α), IL-6, IL-8, GRO-α and
granulocyte–macrophage colony stimulating factor (GM–CSF), which generate
and sustain an inflammatory response.
Inflammatory mediators and chemokines produced in infected epithelial cells
serve as initial triggers for an influx of leukocytes including neutrophils, natural
killer cells, dendritic cells, monocytes, and lymphocytes.
8.
9. Natural history of the disease
It is a chronic keratoconjunctivitis that begins with acute inflammatory changes in
the conjunctiva and cornea and progresses to scarring and blindness.
Trachoma is transmitted through direct contact (fingers and fomites) with
discharges from the eyes of the infected patients or indirect contact through
contaminated clothes or flies.
The incubation period for chlamydial conjunctival infection is 3–10 days.
The earliest symptoms of trachoma are lacrimation, mucopurulent discharge,
conjunctival hyperemia, and follicular hypertrophy.
Acute infection presents as a follicular conjunctivitis, with congestion and oedema
affecting both the palpebral and bulbar conjunctivae.
10. There is papillary hyperplasia, giving the palpebral conjunctiva a velvety
appearance.
Follicles rupture to leave shallow pits termed Herbert’s pits.
Keratitis develops in the cornea.
• Recurrent infection leads to conjunctival scarring
Palpebral conjunctival scarring (cicatrisation) leads to in-turning of the
eyelashes (entropion), which scrape the bulbar corneal surface (trichiasis).
It is the cycle of recurrent infection, with conjunctival scarring and pannus
extending over the cornea, which results in impaired vision or blindness.
11.
12. FIVE STAGES (TYPES) OF TRACHOMA
The world health organization created a grading system to classify the
five stages of blinding trachoma, based on the clinical signs that are
seen as the disease progresses.
13.
14.
15. Signs and symptoms of trachoma
• Irritation of the eye
• Tearing of the eye
• Pain in the eye
• Light sensitivity
• Blurred vision
• Presence of follicles
• Redness
• Scarring
• Corneal opacity.
16. Treatment of trachoma
The WHO alliance for global elimination of trachoma by 2020, aims to
completely eradicate the disease through implementation of the
multifaceted SAFE strategy to prevent and treat trachoma.
S: surgery to correct inturned eyelids and trichiasis
A: Antibiotics (azithromycin) to treat active infection
F: Facial cleanliness to reduce human transmission
E: Environmental improvement eg access to clean water and hygiene
measure.
17. • When trachoma has progressed to inward turning of the lashes, surgery
is necessary to correct the lid position.
• If significant cornel scarring develops, corneal transplantation surgery is
required to restore sight.
Antibiotics
• Tetracycline eye ointment 1% twice daily for 4-6 weeks
• Or erythromycin 500 mg every 6 hours for 14 days
18. Surgical Repair of Trichiasis and Entropion
• Tarsal rotation with bilamellar tarsal rotation or anterior lamellar tarsal
rotation
• Tarsal repositioning with tarsal advancement with or without tarsal rotation
• Posterior lamellar lengthening with the advancement of the posterior
lamella with or without an interpositional mucous membrane or tarsal graft
• Surgery to the anterior lamellar and eyelid margin:
anterior lamellar repositioning
eyelid margin split and eversion
anterior tarsal wedge resection (or grooving) and eversion
• Tarsectomy
19.
20. Nursing Management
• Educate the patient about chlamydia infections
• Encourage patient to practice safe sex
• Encourage the use of condoms
• Encourage patient to remain compliant with medications
• Check labs for culture results
• Administer antibiotics as ordered
• Check labs to ensure female is not pregnant as doxycycline cannot be given
in pregnancy
• Encourage the patient to notify the partner to come in for a screening test
• Encourage patient to follow up in the STD clinic
21. Nursing Diagnosis
• Ineffective healing
• Deficient knowledge
• Anxiety
• Ineffective body defense
• Sexual dysfunction
• Pain
• Low self esteem
• Risk for infection transmission
25. INTRODUCTION
Styes are a type of bacterial infection of the eyelid, typically causing a
painful bump either inside or outside of it. They are a very common eye
problem and usually develop quite quickly, over a few days. Usually
only one eye is affected, although you can develop more than one stye at
a time, even on the same lid.
There are two types of stye: external styes (the common type) and
internal styes (which are quite uncommon). The medical name for a stye
is hordeolum (or hordeola if there are more than one).
26. Introduction
• A hordeolum (stye) is an acute, localized swelling of the eyelid that
may be external or internal and usually is a pyogenic (typically
staphylococcal) infection or abscess.
• Most hordeola are external and result from obstruction and infection
of an eyelash follicle and adjacent glands of Zeis or Moll glands.
Follicle obstruction may be associated with blepharitis.
• An internal hordeolum, which is very rare, results from infection of a
meibomian gland. Sometimes cellulitis accompanies hordeola.
27. External stye (external
hordeolum)
This is the common type of stye.
Technically it is an external stye;
however, it is often just called a stye.
It appears along the edge of the
eyelid, due to infection in the root
(follicle) of an eyelash. It may start
off as a small red lump but, as it
develops into a collection of pus (a
little abscess), it looks like a yellow
pus-filled spot. The edge of the
eyelid around it becomes reddened
and swollen, and the lid is painful.
28. Internal stye (internal
hordeolum)
An internal stye arises when a
type of gland in the main part
of the eyelid (meibomian
gland) becomes infected. The
infection comes to a head on
the inner surface of the eyelid,
against the eyeball, so that
from the outside it is visible
only as a swelling. Internal
styes may be painful, although
often they cause a dull aching
in the eyelid, sometimes with
the sensation of a lump.
29. RISK FACTORS
• Touching eyes with unwashed hands
• Inserting contact lenses without thorough disinfection
• Leaving make up overnight
• Use of expired makeup
• People with blepharitis
• People with acne rosacea, skin condition characterized by redness
• Other medical issues including diabetes, that impaire immune
function
• Previously having styes
30. Etiology
• An acute bacterial infection of the eyelid margin, 90% to 95% of cases
of hordeolum are due to Staphylococcus aureus with Staphylococcus
epidermidis being the second most common cause.
31. Pathophysiology
• Three different glands within the eyelid are implicated in the
pathogenesis of hordeolum when they become infected by S. aureus.
Infection of Zeis and Moll glands (ciliary glands) causes pain and swelling
at the base of the eyelash with localized abscess formation.
• The meibomian glands are modified sebaceous glands that are found in
the tarsal plate of the eyelids. They produce an oily layer on the surface
of the eye that helps to maintain proper lubrication of the eye. When a
meibomian gland becomes acutely infected, it results in an internal
hordeolum. Due to its deeper position within the eyelid, internal
hordeola have a less defined appearance than external hordeolum.
32. Chalazia
• Chalazia occur secondary to mechanical obstruction and dysfunction
of the meibomian gland with subsequent stasis and blockage of the
release of sebum. This condition tends to be subacute to chronic and
presents with a painless nodule within the eyelid or at the lid margin.
33. SIGNS AND SYMPTOMS
• A lump on the top or bottom
eyelid
• Localized pain
• Redness
• Crusting of the eyelid margins
• Pus
• Localized edema
34. • Burning sensation in the eye
• Droopiness of the eyelid
• Itching
• Mucus discharge in the eye
• Light sensitivity
• Discomfort while blinking
• Excessive tear production
• Foreign body sensation in the eye
35. TREATMENT
In most cases stye s resolve on their own with 1-2 weeks but you care give
nursing care like;
• Using a warm compress: A warm compress can help to reduce swelling and
inflammation. This is often the most effective home treatment.
• Washing hands regularly: Regular handwashing prevents particles from
reaching the eye and clogging up the glands. This can prevent styes from
developing and reduces irritation of an existing stye.
• Do not pop styes: Squeezing and popping a stye can release pus and spread
the infection.
• Altering makeup habits: Covering the stye with makeup can slow healing
and irritate the stye. More bacteria can also be spread into the region by
makeup brushes and pencils.
36. Medical treatment
Styes typically resolve on their own without medical intervention. However, if
a person has persistent or repeated styes, doctors may prescribe topical or
oral antibiotics.
The doctor may also give a steroid injection to reduce swelling or
inflammation in the stye.
If these treatments don’t work or the stye converts into a chalazion and
impacts vision surgical removal may be necessary. For this procedure, the
doctor will inject numbing medication around the affected area. They will
then make a little opening in the stye to drain the infected fluid.
Incision and drainage can be done to drain the pus. This is done under local
anesthesia.
38. PREVENTION
• Proper hand washing
• Application of a warm wash-cloth to the eyelids for 1-2 minutes may
decrease occurrences by liquefying the content of the oil gland
• Use clean contact lenses
• Remove eyelashes if loose
