paces 2 - trachoma

8/2/2019 Paces 2 - Trachoma

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TrachomaPACES 2


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What is Trachoma?

Infection of eyes from Chlamydia trachomatis

serotypes A, B, Ba and C

Endemic in certain developing countries

Australia is the only developed country to

have endemic trachoma


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How is Trachoma spread?

Contact with mucopurulent discharge from

infected eyes

Can be eye-to-eye contact, or through infected

environments.

Can also be spread by flies that have

contacted infected eyes.


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Diagnosis of Trachoma requires at

least 2 of the following:

Lymphoid follicles on upper tarsal conjunctiva

Vascular pannus formation

Characteristic conjunctival scarring

Limbal follicles or their sequelae, Herbert-s

pits


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Grading of Trachoma

A: Normal eye

B: Trachomatous inflammation follicular

C: Trachomatous inflammation intense

D: Trachomatous scarring

E: Trachomatous trichiasis F: Corneal opacity


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A: Normal Everted Tarsal Plate


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B: Trachomatous Inflammation -

Follicular

5 follicles on

upper tarsal

conjunctiva 0.5mm diameter

Paler than

surroundingconjunctiva

white/ grey/ yellow


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C: Trachomatous inflammation -

Intense

Red, rough thickened tarsal

conjunctiva

Thickening of tarsal

conjunctiva

Obscures > of deep tarsal

vessels Partially/totally obscures the

numerous follicles


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D: Trachomatous scarring

Glistening/ fibrous white

lines/ bands/ sheets on

upper tarsal conjunctiva

If diffuse, may obscure tarsal

vessels


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E: Trachomatous trichiasis

1 eyelash rubs

on eyeball


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F: Corneal Opacity

Visible corneal opacity

over pupil

Pupil margins are

blurred as viewed

through the opacity

VA affected less than6/18


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Investigations

Giemsa-stained conjunctival smears:

intracytoplasmic chlamydia inclusions

Chlamydia Nuclear Acid Amplification Tests

(NAATs)


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How to treat Trachoma?

Medical Antibiotics azithromycin 20mg/kg

up to 1000mg, single oral dose.

If pt


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SAFE strategy to eliminate blinding

Trachoma

Surgery

Antibiotics

Facial cleansing reduces exposure to flies for

those at risk

Environmental health aims to eliminate

areas for flies


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Bilaminar tarsal rotation

Indications: 1 eyelash turns in

and scratches

cornea when ptlooks straightahead

Evidence of cornealdamage bytrichiasis

Severe discomfortfrom trichiasis


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Fix lid


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Fix lid

Incise skin & muscle


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Fix lid


Evert lid, and incise

conjunctiva and

tarsal plate (same

line as above)


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Fix lid


Evert lid, and inciseconjunctiva andtarsal plate (sameline as above)

Unite the incisionsuse scissors.


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Fix lid


Evert lid, and inciseconjunctiva and tarsalplate (same line asabove)

Unite the incisions use

scissors. Reattach distal fragment

in outwardly rotatedposition


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Before After

paces 2 - trachoma

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