Trachoma

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It is a chronic conjunctivitis caused by infection with Chlamydia trachomatis (bacteria). It is one of  the commonest causes of blindness worldwide. There is a chronic inflammation of the conjunctiva  leading to scarring of the upper eyelid tarsal plate, entropion and in turn of eyelashes.  

Clinical presentation 

  • Photophobia in early stages or re-infection
  • More than 5 follicles in the upper tarsal plate seen as round and white nodules in active diagnostic
  • In late stages, in-turned eyelashes rub on the cornea leading to corneal ulcers
  • Loss of vision due to corneal scarring

Clinical Stages according to World Health Organization 

  • Trachomatous Inflammation Follicular (TF) - presence of at least 5 follicles on the upper tarsal plate
  • Trachomatous Inflammation Intense (TI) – there is intense inflammation, the conjunctival blood vessels cannot be seen
  • Trachomatous Scarring (TS) – presence of white scars in the upper tarsal plate
  • Trachomatous Trichiasis (TT) – presence of some eye lashes rubbing against the cornea
  • Corneal Opacity (CO) – presence of corneal opacity (scar) affecting the central cornea

Investigations 

  • Visual acuity
  • Slit lamp bimicroscopy
  • Conjunctival swab for dipstick test and or PCR

Non-pharmacological Treatment 

  • Face washing and total body hygiene to prevent transmission of disease from one person to the other
  • Environmental improvement/hygiene

Pharmacological Treatment 

A: oxytetracycline eye ointment 3% 24hourly for 6weeks 

OR 

B:  azithromycin (PO) 1g  stat -  for preventive  chemotherapy in mass treatment campaign 

Table 14.1: Dosage of Azithromycin in Children 

Weight (kg) 

I-day regimen

< 15 

20mg/kg 24hourly 

15 – 25 

400mg 24hourly 

26 – 35 

600mg 24hourly 

36-45

800mg 24hourly 

> 45

Dose as per adults 

Note: Preventive chemotherapy in mass treatment campaign is conducted only once a year 

Surgery 

Surgical  correction  of  entropion  in  TT  patients.  This  procedure  can  be  done  at  a  dispensary  or  health centre and community level by a trained health worker. 

Referral: Refer all patients with recurrent TT or lower Eyelid TT to Oculoplastic Surgeon at Regional Referral or Zonal Referral Hospital for proper assessment and surgical management.