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.