Trachoma
Yaajnavalkya Hebbar k
What’s it ?
It is chronic keratoconjunctivitis,
affecting the superficial epithelium
of the conjunctiva and cornea
simultaneously.
Characterised by a mixed follicular
and papillary response of
conjunctival tissue.
Etiology
Causative organism : Chlamydia
trachomatis belonging to PLT
group.
Predisposing factors
Age - contracted in infancy and
early childhood.
Sex - more in females
Climate - dry and dusty weathers
Seen in poor /lower socioeconomic
status group.
Mode of infection
Direct spread can occur through
contact by air borne or water borne
modes.
Vector - flies
Material transfers.
Clinical features
Active Cicatricial
trachoma trachoma
Clinical features - Active
Trachoma
Incubation period 5-21 days.
Symptoms
In absence of secondary infection :
minimal symptoms, occasional lacrimation,
mild foreign body sensations, slight stickiness
of eyes, scanty mucoid discharge.
In presence of secondary infection:
symptoms of mucopurulent conjunctivitis is
seen.
Conjunctival Signs
Upper tarsal and forniceal conjunctiva congestion.
Conjunctival follicles resembling boiled sagograins
and are seen on upper tarsal conjuctiva and
fornix.
Follicles are formed due to scattered aggregation
of lymphocytes and other cells in adenoid layer.
Central part of each follicle is made up of
mononuclear histiocytes, Leber cells.
Papillary hyperplasia is seen.
Corneal Signs
Superficial keratitis
Herbert follicles in limbal area.
Progressive pannus is seen.
Corneal ulcer can develop
later on.
Progressi
ve
pannus
Phase of Cicatricial
trachoma
Conjunctival signs
Conjunctival scarring - irregular, star shaped
or linear.
Concretions are hard looking whitish
deposits are seen.
Pseudocyst, xerosis .
Corneal signs
Regressive pannus
Herbert pits
Corneal opacity
Other sequelae maybe corneal ectasia, corneal
xerosis, total corneal pannus.
Corneal signs
Regressive pannus
Herbert pits
Corneal opacity
REGRESSIVE PANNUS
Other sequelae maybe corneal ectasia, corneal
xerosis, total corneal pannus.
Other signs
Lid signs - trichiasis, entropion, tylosis, ptosis,
madarosis and ankyloblepharon.
Lacrimal apparatus sequelae - chronic dacrocystitis,
chronic dacryoadenitis.
Treatment
Treatment of active trachoma
Antibiotic therapy.
Azithromycin 20mg/kg body wt.
Erythromycin 250mg QID or 500mg BD
Doxycycline 100 mg orally twice a day for 10 days
Tetracycline (1%) or erythromycin (1%) eye ointment.
Treatment of cicatricial trachoma
Artificial tears such as 1% carboxymethylcellulose for soothing
effect.
Surgical therapy :
1) Conjuctival sequelae - concretions removed using hypodermic
needle.
2) eyelid sequelae- trichiasis should be treated with permanent
lash removal by electrolysis or cryolysis. Bilamellar tarsal reduction
for multiple misdirected eyelashes. Cicatricial entropion to be
treated surgically.
3) corneal scarring- Penetrating keratoplasty, keratoprosthesis
Prophylaxis
Thank you
