Trachoma: Difference between revisions
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[[File:Gray894.png|thumb|The tarsi and their ligaments. Right eye; anterior view.]] | [[File:Gray894.png|thumb|The tarsi and their ligaments. Right eye; anterior view.]] | ||
[[File:eyelid glands.png|thumb]] | [[File:eyelid glands.png|thumb]] | ||
* | *Most common cause of infectious blindness worldwide | ||
*Caused by [[Chlamydia trachomatis]] | *Caused by [[Chlamydia trachomatis]] | ||
**Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals) | **Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals) | ||
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**Caused by structural changes to the inner eyelid | **Caused by structural changes to the inner eyelid | ||
***Scarring of the inner eyelid that leads to buckling of the lid | ***Scarring of the inner eyelid that leads to buckling of the lid | ||
****This causes the eyelashes to turn inwards | ****This causes the eyelashes to turn inwards (Trichiasis) and rub on the cornea causing repetitive trauma that leads to opacities and scarring of the cornea | ||
*Major complications include [[corneal ulcers]] | *Major complications include [[corneal ulcers]] | ||
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==Management== | ==Management== | ||
* | *S.A.F.E. strategy proposed by WHO | ||
** | **S - Surgery | ||
***Bilamellar tarsal rotation procedure recommended by WHO | ***Bilamellar tarsal rotation procedure recommended by WHO | ||
** | **A - Antibiotics | ||
***Tetracycline 1% eye ointment | ***Tetracycline 1% eye ointment | ||
**** | ****Adherence issues secondary to difficulty in use and uncomfortable to apply | ||
***[[Azithromycin]] (20mg/kg) single dose | ***[[Azithromycin]] (20mg/kg) single dose | ||
****Relatively expensive in resource poor settings | ****Relatively expensive in resource poor settings | ||
** | **F - Facial cleanliness | ||
***Helps decrease disease transmission | ***Helps decrease disease transmission | ||
** | **E - Environmental management | ||
***WHO emphasizes access to latrine and clean water | ***WHO emphasizes access to latrine and clean water | ||
Revision as of 09:39, 22 March 2026
Background
- Most common cause of infectious blindness worldwide
- Caused by Chlamydia trachomatis
- Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals)
- More than 6 million blind secondary to trachoma and more than 150 million in need of treatment
- Typically affects most marginalized populations in the world
- Those with limited access to clean water and sanitation
- Part of the group of diseases known as neglected tropical diseases
Clinical Features
Acute
- Conjunctivitis-like symptoms
- Conjunctival follicles (white lumps) on the inner upper eyelid
- Non-specific inflammation and thickening of the conjunctiva
Chronic
- Known as the "quiet disease" because of its slow chronic course
- Blindness after repeated infections
- Caused by structural changes to the inner eyelid
- Scarring of the inner eyelid that leads to buckling of the lid
- This causes the eyelashes to turn inwards (Trichiasis) and rub on the cornea causing repetitive trauma that leads to opacities and scarring of the cornea
- Scarring of the inner eyelid that leads to buckling of the lid
- Caused by structural changes to the inner eyelid
- Major complications include corneal ulcers
Differential Diagnosis
Evaluation
- Clinical diagnosis
WHO classification
- Simplified grading system composed of 5 clinical signs of infection
- Follicular trachomatous inflammation (TF)
- ≥5 follicles >0.5mm on the superior tarsal conjunctiva
- Intense trachomatous inflammation (TI)
- Hypertrophy of the papilla and inflammatory thickening of the superior tarsal conjunctiva (must obscure more than half of the deep vessels)
- Trachomatous scarring (TS)
- Scarring in the superior tarsal conjunctiva
- Trachomatous trichiasis (TT)
- One or more ingrown eyelash in contact with the globe or evidence of eyelash loss (epilation)
- Corneal opacity
- Must blur part of the pupil margin
- Follicular trachomatous inflammation (TF)
Management
- S.A.F.E. strategy proposed by WHO
- S - Surgery
- Bilamellar tarsal rotation procedure recommended by WHO
- A - Antibiotics
- Tetracycline 1% eye ointment
- Adherence issues secondary to difficulty in use and uncomfortable to apply
- Azithromycin (20mg/kg) single dose
- Relatively expensive in resource poor settings
- Tetracycline 1% eye ointment
- F - Facial cleanliness
- Helps decrease disease transmission
- E - Environmental management
- WHO emphasizes access to latrine and clean water
- S - Surgery