TRACHOMA

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Slide 1 :

TRACHOMA Dr. SATHISH

Slide 2 :

CONTENTS INTRODUCTION ETIOLOGY SOURCE & MODES OF INFECTION CLINICAL PROFILE SYMPTOMS SIGNS GRADING SEQUELAE & COMPLICATIONS DIAGNOSIS DIFFERENTIAL DIAGNOSIS MANAGEMENT

Slide 3 :

INTRODUCTION Egyptian ophthalmia Chronic keratoconjunctivitis affecting the sup. Epithelium of conjunctiva & cornea simultaneously. Characterised by mixed follicular & papillary response of conjunctival tissue. Leading cause of preventable blindness North Africa, Middle east, South east Asia.

Slide 4 :

ETIOLOGY Causative organism: Chlamydia trachomatis Epitheliotropic, produces H.P bodies Immunofluorescence– 11 serotypes Hyperendemic trachoma– A,B,Ba,C Paratrachoma– D-K Serotypes Predisposing factors– Age, sex, Race, Climate, Socioeconomic status, Environmental factors

Slide 5 :

SOURCE & MODES OF INFECTION Conjunctival discharge Modes Direct Vector Material- tonometers, towel, handkerchief,bedding

Slide 6 :

CLINICAL PROFILE Incubation period: 5-21 days Onset– Subacute, rarely acute Secondary bacterial infection Early stages– trachoma dubium

Slide 7 :

SYMPTOMS SECONDARY INFECTION ABSENT: Mild foreign body sensation Occasional lacrimation Slight stickiness of lids Scanty mucoid discharge PRESENT: Discomfort & foreign body sensation Mild photophobia Mucopurulent discharge Stickiness of lids Slight blurring of vision Coloured halos

Slide 8 :

SIGNS CONJUNCTIVAL SIGNS: Congestion of upper tarsal & forniceal conjunctiva Conjunctival follicles: (boiled sagograins) Upper tarsal conjunctiva & fornix Bulbar conjunctiva- pathognomonic Papillary hyperplasia: reddish, flat raised areas Conjunctival scarring: Irregular, shaped, Arlt’s line- linear scar present in the subtarsalis

Slide 9 :

SIGNS contd.. CORNEAL SIGNS: Superficial keratitis Herbert follicles-- limbus Pannus– infiltration of cornea associated with vascularization, Progressive– infiltration ahead of vascularization Regressive– vessels extend beyond infiltration

Slide 10 :

CORNEAL SIGNS contd.. Corneal ulcer: Advancing edge of pannus Herbert pits: Oval or circular pitted scars, healing of herbert follicles in limbus Corneal opacity: End of trachomatous corneal lesions.

Slide 11 :

GRADING McCallan’s WHO Jones

Slide 12 :

McCALLAN’S CLASSIFICATION Stage- 1: (Incipient or stage of infiltration) Characterised by hyperemia of palpebral conjunctiva & immature follicles. Stage- 2: (Established or stage of florid infiltration) Mature follicles, papillae & progressive papillary pannus. Stage- 3: (Cicatrising or stage of scarring) Scarring of palpebral conjunctiva. Stage- 4: (Healed or stage of sequelae) Disease is quiet & cured, sequelae give rise to symptoms.

Slide 13 :

WHO CLASSIFICATION(FISTO) TF: Trachomatous inflammation- follicles TI: Trachomatous inflammation- intense TS: Trachomatous scarring TT: Trachomatous trichiasis CO: Corneal opacity

Slide 14 :

SEQUELAE LIDS– Trichiasis, entropion, tylosis,ptosis, madarosis & ankyloblepharon. CONJUNCTIVA– Concretions, pseudocyst, xerosis & symblepharon. CORNEA– Opacity, ectasia, xerosis, total pannus. OTHERS– Chronic dacryocystitis & chronic dacryoadenitis

Slide 15 :

COMPLICATIONS Corneal ulcer– occur due to rubbing by concretions or trichiasis with superimposed bacterial infection.

Slide 16 :

DIAGNOSIS Clinical– as per WHO classification Laboratory: Conjunctival cytology Detection of inclusion bodies ELISA PCR Isolation of Chlamydia Serotyping of TRIC agents

Slide 17 :

DIFFERENTIAL DIAGNOSIS Trachoma with follicular hypertrophy: Distribution of follicles Associated signs Laboratory diagnosis . Trachoma with predominant papillary hypertrophy: Papillae pH of tears Discharge Follicles & pannus Conjunctival cytology

Slide 18 :

MANAGEMENT Includes Curative & control measures For active trachoma, Topical & systemic antibiotics. Therapeutic regimes: ( TOPICAL ) Tetracycline or erythromycin 1% oint. 4 times a day for 6 weeks. Sulfacetamide 20% eye drops 3 times a day + 1% tetracycline oint. at bedtime for 6 weeks.

Slide 19 :

MANAGEMENT contd.. Systemic therapy: Tetracycline or erythromycin 250 mg orally, 4 times a day for 3-4 weeks. Doxycycline 100 mg orally twice daily for 3-4 weeks or Azithromycin 1 gm or 250 mg od for 4 days

Slide 20 :

MANAGEMENT contd.. Combined regime: Tetracycline or erythromycin oint. 4 times a day for 6 weeks. Tetracycline or erythromycin 250 mg orally 4 times a day for 2 weeks

Slide 21 :

MANAGEMENT contd.. TRACHOMA SEQUELAE: Concretions - removed with a hypodermic needle Trichiasis- epilation, electrolysis. Entropion-corrected surgically Xerosis-treated by artificial tears.

Slide 22 :

PROPHYLAXIS Hygienic measures Early treatment of conjunctivitis Blanket antibiotic therapy

Slide 23 :

THANK YOU

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