TRACHOMA

Trachoma (granular conjunctivitis) is the world’s leading cause of preventable blindness BBC Documentary MedicineNet.com (quote)

Trachoma is a contagious infection in the eye caused by chlamydia trachomatis which causes blindness after multiple reinfections. BBC Documentary MedicineNet.com (quote)

Causes Chlamydia trachomatis Spread by direct contact with eye, nose and throat secretions from affected individuals of with fomites such as towels, washcloths etc Flies can be a route Untreated repeated trachoma infections result in entropion – eyelids turn inward casusing the eyelashes to scratch the cornea

Chlamydia trachomatis is spread through direct contact with an infected person. The most common agents of transmission are hands, handkerchiefs, and towels. WHO “Water Sanitation Health: Water-related Diseases” http://trachoma.org/world’s-leading-cause-preventable-blindness (1st sentence) WHO Prevention of Blindness and Visual Impairment

Flies also play a major role in the spread of the disease. WHO Prevention and Blindness and Visual Impairment

Poor sanitation, dirty water, and lack of hygiene are causes of trachoma. MedicineNet.com

Signs and symptoms Symptoms of conjuctivitis, pink eye White lumps in the undersuface of the upper eyelid (follicles) Non specific thickening with papillae Irrtating and watery discharge Purulent discharge Scarring in the eyelid Lashes rub on the eye – trichiasis Linear scar over the lid – arlt’s line Resolved follicles leave small gaps – herberts pits Swollen eyelids Sensitivity to bright lights

WHO classification Trachomatous inflammation, follicular (TF)—Five or more follicles of >0.5 mm on the upper conjunctiva Trachomatous inflammation, intense (TI)—hypertrophy and inflammatory thickening of the upper conjunctiva with the presence of follicles Trachomatous scarring (TS)—Presence of scarring in conjunctiva. Trachomatous trichiasis (TT)—At least one ingrown eyelash touching the globe. Corneal opacity (CO)—Corneal opacity or blurring part of the pupil margin

WHO grading chart

Trachomatous inflammation-follicular WHO grading chart

Trachomatous inflammation-follicular and intense WHO grading chart

Trachomatous scarring

Trachomatous trichiasis

Management Surgery Tarsal rotation procedure – for trichiasis SAFE MEASURES – SURGERY ANTIBIOTICS FACIAL CLEANLINES EVIRONMENTAL HYGIENE Surgery Tarsal rotation procedure – for trichiasis This involves incision of the scarred lid and external rotation of the distal margin by using 3 sutures

Antibiotics Azithromycin – single oral dose of 20mg/kg Or Topical tetracycline – ointment twice a day for six weeks

Life style measures Facial cleanliness – children's with grossly visible nasal discharge, ocular discharge or flies on their faces are atleast twice likely to have trachoma Community based health education Environmental change to increase access to clean water and improved sanitation