MEKELLE UNIVERSTY COLLEGE OF HEALTH SCIENCEAYDER REFERRAL HOSPITAL

OPHALMOLOGY UNIT SEMINAR ON TRACHOMA PREPARED BY GIRMAWI.M

CONTENT

• Definition• Epidemiology• Etiology• Risk factor• Clinical presentation• Diagnosis• Treatment

TRACHOMA

• one of the major blinding diseases• most common infectious cause of blindness.

EPIDEMILOGY

• The WHO estimates that 84 million people suffer from active trachoma and most of these are under 15 years of age.

• over 7 million have trichiasis (ingrown eyelashes

• Up to 1.3 million are thought to be blind due to the eye disease

CONT’D Endemic in 50 countries Confined to poor developing countries -Africa -Middle east -Asia -Latin America -Pacific Island

ETIOLOGY

• Trachoma is caused by the organism Chlamydia trachomatis which is a

- highly infectious - subdivided into a number of serotype serotype( A,B,C) - associated with eye to

eye infection

serotype (D-K) - associated with genital tract infection and ophthalmic neonatrem(newborn conjunctivitis)

c.trachomatis inclusion bodies

TRANSMISION

By direct contact with Eye secretion Nasal secretion Throat affected secretion

By contact with fomites such as Hand kerchiefs Towels or wash cloths contaminated with these secretion Eye seeking flies

• Episodes of infection usually begin in childhood, while blindness from corneal scarring occurs after repeated infection, untreated inflammation,scarring of the eyelids, distortion of the eyelashes, associated trauma and secondary bacterial infection.

Risk Factors for Trachoma

• Environmental factors -lacks effective sanitation, and adequate

fresh water supplies -presence of animals kept near to dwellings

and piles of animal dung provide breeding places for flies

- Flies are attracted to red eyes with discharge, and carry the organism Chlamydia trachomatis to the eyes of others within a family or a community, both children and adults

Risk factor

o Dry o Dusty o Dirty o Dung o Discharge o Density (overcrowding in the home

factors which influence transmission of infection

-Flies -Faeces -Faces -Fingers -Fomites (contaminated material or objects such as clothing or towels)

CLINICAL MANIFESTATION

• The clinical manifestations of trachoma can be divided into two phases:

1- active trachoma and 2- cicatricial trachoma

ACTIVE TRACHOMA

Active trachoma - mostly seen in young children -majority are asymptomatic -cause mild self limited follicular conjunctivitis - Mild irritation -Red eyes

CONT’D

-Discharge - 2ry bacterial infection -Eyelid or Conjunctival edema -Pain and photophobia -Blurring of vision

Physical finding of active trachoma is - follicle on upper tarsal conjunctiva

CIACATRICIAL DISEASE

• Commonly seen in adult Repeated episodes of infection cause marked conjunctival

inflammation

leading to eyelid scarring→Eyelid scar tissue eventually contracts

distort the lid margin leading to entropion (inward rolling of the eyelid) and

subsequent trichiasis (ingrown eyelashes).

CONT’D

Eyelash abrasion on the cornea leads to corneal edema, ulceration and scarring. If untreated, corneal pannus (inflammatory

vascular tissue) eventually develops followed by corneal opacification, and loss of vision.

WHO TRACHOMA GRADING SYSTEM

TF- Trachomatous Inflammation – FollicularTI – Trachomatous Inflammation – IntenseTS –Trachomatous ScarringTT – Trachomatous TrichiasisCO –Corneal Opacity

TF-FOLLICULAR

• Cxed by - presence of 5 or more follicle -each 0.5 mm in diameter -Rounded -Slightly raised -Usually paler than the remaining conjunctiva

surface -on the flat surface of the upper tarsal conjunctiva - which are tiny accumulation of lymphoid cell

TI - INTENSE

• The tarsal conjunctiva -thickened and inflamed -diffuse inflammatory infiltration

with edema and enlarged vascular papillae -more than one half of the deep

conjunctival vessel must be covered with inflamed conjunctiva so that the blood vessel are no longer visible.

Trachomatous Scarring

• Presence of scarring and fibrosis in the tarsal conjunctiva.

• Appear as white lines.• Common in the older pts.• Causes distortion of the upper eyelid.

Trachomatous Trichiasis

• Trichiasis is defined as 1 or more eyelashes rubbing against the eyeball or evidence of lash removal.

• Common in women and starts at adolescence.• Due to advanced conjunctival scarring and the

distortion of the upper eyelid.

Corneal Opacity

• This is when the scarring is central and very dense enough to obscure part of the pupil margin.

• Usually after 20 yrs.• Reduced vision.• Much improvement is not expected even after

treatment.

DDX

• Allergic conjunctivitis• Bacterial conjunctivitis• Neonatal conjunctivitis• Viral conjunctivitis• Trichiasis

Allergic conjunctivitis

Usually Present in children and is a chronic condition

Particularly common spring and summer - itching , red eyes, irritable -In the florid state, papillae appear on

the tarsal conj. ---Cobblestone appearance.Thickening of tissue at the CSM helps

distinguish it from trachoma.

TI Vs ALLERGIC CONJ.

Neonatal Chlamydia Conjunctivitis

• It is caused by Chlamydia trachomatis serovars D to K acquired from the mother during delivery.

• Presentation is 5-12 days postpartum with mucopurulent discharge, eyelid edema and

papillae.

TREATMENT OF TRACHOMA

TREATMENT OF ACTIVE TRACHOMA

1. The application of tetracycline 1 % eye ointment to both eyes two times each day for 6 weeks, or

.

CONT’D

• 2. a single oral dose of 20mg azithromycin per kilogram of body weight, to a maximum of 1g

Do antibiotics improve all grades of trachoma?

CONT’D

NO Azithromycin or tetracycline ointment are

effective only against active trachoma, particularly follicular trachoma (TF) and intense

inflammatory trachoma (TI).

• Scarring of the eyelids causes the eyelashes to be distorted and these may constantly rub against the eyeball.

• When only one or two eyelashes are causing trouble, a simple temporary measure is to remove each eyelash using forceps.

CONT’D

• A little mirror or polished surface may help in the removal of irritating eyelashes.

• The eyelashes grow again in 4 to 6 weeks, the procedure has to be repeated when irritation recurs.

CONT’D

• A more permanent method of dealing with an isolated ingrowing eyelash is to apply electrolysis, after injecting local anesthetic into the eyelid at the base of the eyelash.

BILAMELLAR TARSAL ROTATION Patient who has severe eyelid scarring causing the eyelid to turn

inward (entropion) with many eyelashes rubbing on the cornea are treated with eyelid surgery called Bilamellar tarsal rotation.

which is designed to rotate the eyelashes and give considerable relief to the patient.

Can we improve vision after corneal scarring?

If the cornea is considerably scarred, then it is seldom possible to improve the eyesight. Corneal grafting is not usually successful in these eyes.

However, if there is an area of one cornea which does remains clear, where the scarring effects of trachoma involve the cornea in each eye, an optical iridectomy may be considered.

• In this surgical procedure, the pupil of the eye is made bigger so that the patient can look through the widened pupil which has been surgically enlarged behind the clear area of cornea.

PREVENTION OF TRACHOMA

Personal and Community Hygiene1. Regular daily face-washing (and hand-

washing).

2. The basic need of a suitable water supply near at hand.

Cont’d

3. Ventilated pit latrines to improve community hygiene.

4. Animals, especially cattle, housed, if possible, some distance from the family home.

Cont’d

5-Community Health education

WHO launched Global Elimination of Trachoma 2020 (GET).

• The World Health Organization (WHO) is aiming to eliminate trachoma as a blinding disease by 2020. A useful strategy is the SAFE strategy:

- Surgery for in-turned eyelashes,

-Antibiotics for active disease,

Cont’d

• Face washing (or promotion of facial cleanliness), and

Environmental improvement to reduce transmission

THANK YOU