Study well students

1. TRACHOMA
BY A.C MBULO

2. Scope
• Introduction
• Definitions
• Cause/incubation
• Pathophysiology
• Clinical features
• Risk factors

3. • Transmision
• Who Grading system of trachoma
• Mc callans classification
• Diagnosis
• Management
• Complications
• Prevention

4. INTRODUCTION
Trachoma is a disease of the eye caused by infection with the bacterium
Chlamydia trachomatis.
It is a public health problem in many countries
Blindness from trachoma is irreversible.
Based on March 2019 data, 142 million people live in trachoma
endemic areas and are at risk of trachoma blindness.
 Over time, scar tissue or ulcers can form that lead to blindness

5. • Trachoma is the Leading cause of infective blindness globally > 150
million people have been affected.
• It is associated with poor hygiene and inadequate sanitation.
Recent estimates show 59 countries are endemic and india has high
burden.
• Trachoma is the world’s leading cause of preventable blindness of
infectious origin.

6. DEFINITION
Trachoma is a disease of the eye caused by infection with the bacterium
Chlamydia trachomatis characterized by chronic inflammation of the
conjunctiva.
Trachoma is a chronic keratoconjuctivitis caused by chlamydia
trachomatis

7. Trachoma is a contagious bacterial infection of the eye caused by
Chlamydia trachomatis Characterized by hard pustules, inflamed
granulation on the inner surface of the eye lids, Inflammation of the
membrane and subsequent involvement of the cornea.

8. What is the cause of trachoma?
Cause : Chlamydia trachomatis.
• The bacteria responsible for trachoma is Chlamydia trachomatis. There
are different types of Chlamydia trachomatis. Types A, B, Ba, and C
cause blinding trachoma. Other types (D to K) are associated with
sexually transmitted chlamydia infection.
Incubation period 5 to 21 days
• Onset subacute but on massive outbreaks can be acute

9. Trachoma: Pathophysiology
Trachoma is a disease of the eye which can be treated by antibiotics and
prevented by good personal and environmental hygiene. When there is
Repeated episodes of reinfection chronic intense conjunctival
inflammation ocurs (active trachoma),which leads to tarsal conjunctival
scarring. The scaring distorts the upper tarsal plate and, in some
individuals, leads to entropion and trichiasis (cicatricial trachoma).The
end result includes corneal abrasions; corneal scarring and opacification;
and ultimately blindness.

10. Clinical Features
Signs and Symptoms
Watering, foreign body sensation,
 Rediness of eyes.
Mucopurulent discharge

11. Mild itching and irritation of the eyes and eyelids
Eyelid swelling
Photophobia (Light sensitivity)
Blurring
Mild pain (Eye pain)

12. Risk factors
• Factors that increase your risk of contracting trachoma include:
• Poverty. Trachoma is primarily a disease of extremely poor populations
in developing countries.
• Crowded living conditions. People living in close contact are at greater
risk of spreading infection.
• Poor sanitation. Poor sanitary conditions and lack of hygiene, such as
unclean faces or hands, help spread the disease.

13. • Age. In areas where the disease is active, it's most common in children
ages 4 to 6.
• Sex. In some areas, women's rate of contracting the disease is two to six
times higher than that of men.
• Flies. People living in areas with problems controlling the fly
population may be more susceptible to infection.
• Lack of latrines. Populations without access to working latrines — a
type of communal toilet — have a higher incidence of the disease.

14. RISK FACTORS
6 D’S
1. Dry
2.Dusty
3.Dirty
4.Dung
5.Discharge
6.Density (Crowding)

15. PREDISPOSING FACTORS
1.Age more infancy/childhood
2.Sex common in females
3.Dry and dusty environment
4.Low socio economic status, unhygienic conditions, lack of sanitation.

17. House fly belongs to the family Muscidae. It is classified as Musca
domestica.

18. TRANSMISSION OF TRACHOMA
5 F’S
1.Fingers
2.Flies
3.Face
4.Faeces
5.Fomites

19. WHO GRADING SYSTEM
• Trachomatous inflammation -- follicular (TF):Active disease. The
first sign is the presence of follicles, which are small bumps formed by
swollen lymph tissue on the back of the upper eyelid and sometimes
extending to the top part of the eye. The presence of five or more
follicles greater than 0.5 mm in size on the conjunctiva lining the back
of the upper eyelid is considered grade TF. No scarring if treated
properly.

21. • Trachomatous inflammation -- intense (TI):severe disease, needs
urgent treatment The next phase is swelling (inflammation) of the
conjunctiva that obscures 50% or more of the view of the normal deeper
blood vessels of the conjunctiva. (tarsal vessels; papillae are present)

23. • Trachomatous scarring (TS):intensive infection. Bands of scar tissue
form within the conjunctiva lining the inside of the upper eyelid. visible
fibrous white bands on tarsal.

25. • Trachomatous trichiasis (TT): The bands of scar tissue tighten,
causing the lid margins to turn inward (entropion) and the eyelashes to
rub against the eye (trichiasis). Over time, this rubbing results in
abrasions of the cornea, the clear central covering of the front of the
eye.

27. • Corneal opacity (CO): Corneal abrasions can lead to infectious ulcers and
ultimately opaque scarring that blocks light from entering the eye, leading to
blindness.

29. Mc CALLANS CLASSIFICATION
Stage 1.incipient trachoma/stage of infiltration
Hyperemia of palpebral conjunctiva and immature follicles
Stage 2. Stage of florid infiltration
Mature follicles, papillae, progressive pannus
Stage 3. Cicatarizing trachoma/stage of scarring
Stage 4. healed trachoma/stage of sequale

30. Diagnosis
Require atleast 2 of the following clinical features
1.Follicles on the upper tarsal conjactiva
2.Limbal follicles and their sequelae (Herbert pits)
3.Typical tarsal conjuctival scaring
Vascular pannus most marked on the superior limbus.

32. MANAGEMENT
A) Treatment of active disease and sequalae
B) Prevention
Treatment of active disease
Antibiotics-Main stay
Oral Azithromycin 1gm stat (20mg/kg)
Tetracycline or erythromycin 250mg QID for 4weeks
Doxycycline 100mg BD for 4weeks.

33. Topical-based for individual cases, cheaper,no systemic side effects
1% teracyclines/ erythromycin eye ointment QDS FOR 6 WEEKS
20% Sulfacetamide eye drops thrice daily with 1% tetracycline ointment
at bed time for 6weeks
Other topical antibiotics for secondary bacterial infections
Lubricants
Analgesics

34. Blanket antibiotic therapy/intermittent therapy (WHO)
In endemic areas to control intensity and severity
Regimen -1% tetracycline ointment BD 7days/Month times 6months.

35. Trachoma: Prevention and control
Prevention of trachoma-related blindness require a number of
interventions.
The world health organization (WHO) And their partners endorse the
surgery,antibiotics,facial cleanliness,and environment (SAFE) Strategy
for trachoma control.

36. SAFE STRATEGY:SURGERY
• “S” in the SAFE strategy stands for trichiasis Surgery.
• Eyelid surgery to correct trichiasis is important in people with
trichiasis,who are at high-risk for trachomatous visual impairment and
blindness.
• Eyelid surgery to correct entropion and /or Trichiasis may prevent
blindness in individuals at immediate risk.

37. SAFE STRATEGY : ANTIBIOTICS.
The WHO recommends 2 antibiotics for trachoma control.
1.Oral azithromycin
2.Tetracycline eye ointment.
Azithromycin eye drops have also been shown to be very effective.

38. • Azithromycin is better than tetracycline,but it is more expensive.
• Azithromycin is the drug of choice because it is easy to administer as a
single oral dose.
• Its administration can be directly observed.
• Complince is higher than with tetracycline and can actually be
measured,where as,with the home administration of tetracycline the
level of compliance is unknown.

39. • Azithromycin has high efficacy and a low incidence of adverse effects.
• When adverse effects occur ,they are usually mild ,gastrointestinal upset
and rash are the most common adverse events.
• Infection with C. TRACHOMATIS occurs in the nasopharynx;
therefore/patients may reinfect themselves if only topical antibotics are
used.

40. • SAFE STRATEGY:Environmental improvement
General improvemrnts in personal and community hygiene are almost
universally associated with a reduction in the prevalence and eventually
the disappearance of trachoma.
Environmental improvement activities include the promotion of
improveved water supplies and
Improved household sanitation,particularly methods for safe disposal of
human feces.

43. Complications
• One episode of trachoma caused by Chlamydia trachomatis is easily
treated with early detection and use of antibiotics. Repeated or
secondary infections can lead to complications, including:

44. Scarring of the inner eyelid
Eyelid deformities, such as an inward folding eyelid (entropion) or
ingrown eyelashes (trichiasis)
Corneal scarring or cloudiness
Partial or complete vision loss

45. National trachoma control program
Launched in 1963
SAFE strategy
Training at root level
Health education
GET 2020 Global elimination of trachoma by 2020
Launched by WHO
Objective to eliminate trachoma as blinding disease.
ICTC international Coalation of Trachoma Control

46. Prevention
• If you've been treated for trachoma with antibiotics or surgery, reinfection is
always a concern. For your protection and for the safety of others, be sure
that family members or others you live with are screened and, if necessary,
treated for trachoma.
• Trachoma can occur worldwide but is more common in the Middle East,
North Africa, sub-Saharan Africa, and areas of southern Asia and China.
When in regions where trachoma is common, take extra care in practicing
good hygiene, which can help prevent infection.
1.Proper hygiene practices include:

47. 2.Face washing and hand-washing. Keeping faces clean may help
break the cycle of reinfection.
3.Controlling flies. Reducing fly populations can help eliminate a major
source of transmission.
4.Proper waste management. Properly disposing of animal and human
waste can reduce breeding grounds for flies.
5.Improved access to water. Having a fresh water source nearby can
help improve hygienic conditions.
6.No trachoma vaccine is available, but prevention is possible. The
World Health Organization (WHO) has developed a strategy to prevent
trachoma, with the goal of eliminating it by 2020. The strategy, titled
SAFE, as indicated above:

48. • PROPHYLAXIS
Good personal and environmental hygiene.
Health education ON Trachoma prevention.
Use of common towels, handkerchiefs are discouraged
Clean water supply for washing
Flies control- insecticides, good sewerage garbage disposal, window screen
protectors
Prevention of recurrent infections
Early detection and treatment