Clinical features:

Ø  Trachoma is an infectious disease caused by the Chlamydia trachomatis type A, type B, type C bacterium which produces a characteristic roughening of the inner surface of the eyelids.

Ø  It is also called granular conjunctivitis and Egyptian ophthalmia and is the leading cause of infectious blindness in the world.

Ø  Complaints of mild itching and irritation of the eyes and eyelids, purulent or mucoid discharge from the eyes, photophobia, blurred vision and eye pain are common.

Ø  Diseases progresses slowly, and the more painful symptoms may not emerge until adulthood.

Ø  Presence of at least two of the following signs: superior tarsal follicles, limbal follicles (Herbert’s pit), typical conjunctival scarring and vascular pannus.

Ø  Transmission of the disease occurs vial ocular and nasal secretions (direct spread, indirect via fomites, coughing/sneezing).

Grading of severity:

(Mac Callan Classification)

Stage 1: Superior tarsal follicles, mild superior SPK, and pannus, often proceeded by purulent discharge and tender preauricular nodes.

Stage 2: Florid superior tarsal follicular reaction (2a) or papillary hypertrophy (2b) associated with superior corneal SEIs, pannus, and limbal follicles.

Stage 3: Follicles and scarring of superior tarsal conjunctiva.

Stage 4: No follicles, extensive conjunctival scarring.

Late complications: Severe dry eyes, trichiasis, entropion, keratitis, corneal scarring, superficial fibrovascular pannus, Herbert pits (scarred limbal follicles), corneal bacterial superinfection, and ulceration.

World Health Organization (WHO) Classification

TF (Trachomatous inflammation: follicular): More than five follicles on the upper tarsus.

TI      (Trachomatous    inflammation:     intense):     Inflammation with thickening obscuring more than 50% of the tarsal vessels.

TS (Trachomatous scarring): Cicatrization of tarsal conjunctiva with fibrous white bands.

TT (Trachomatous trichiasis): Trichiasis of at least one eyelash.

CO (Corneal opacity): Corneal opacity involving at least part of the pupillary margin.

Treatment:

The SAFE strategy for trachoma management supported by the WHO and other agencies encompasses

S Surgery for trichiasis A

Antibiotics for active disease F Facial hygiene and

E Environmental improvement

1.       Antibiotics should be administered to those affected and to all family members. Single antibiotic course is not always effective in eliminating infection in an individual, and communities may need to receive annual treatment to suppress infection.

2.       A single dose of azithromycin (20 mg/kg up to 1g) is the treatment of choice.Topical 1% tetracycline ointment is less effective than oral treatment; it should be given for 6 weeks.

3.       Surgery is aimed at relieving entropion and trichiasis and maintaining complete lid closure

4.       Facial cleanliness is a critical preventative measure. with bilamellar tarsal rotation.

5.       Environmental improvement such as access to adequate water and sanitation, as well as control of flies, is important.