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INTRODUCTION

 Trachoma is an infectious disease of the eye caused by the bacterium Chlamydia


trachomatis leads to conjunctival inflammation and scarring, trichiasis and ulitimately
blinding corneal opacification, and is the world's leading cause of preventable blindness.
 Trachoma is the commonest infective cause of blindness in the world (15-20%)

 It is spread worldwide but highly prevalent in North Africa, Middle East and certain
Regions of south-East Asia.

DEFINITION
 Trachoma is a chronic keratoconjunctivitis, primarily affecting the superficial
epithelium of conjunctiva and cornea simultanously.
 It is characterised by a mixed follicular and papillary response of conjunctivitis

EPIDEMOLOGICAL TRIAD
AGENT

HOST ENVIRONMENT
AGENT:- CHLAMYDIA TRACHOMATIS

HOST :-

AGE:- Infancy and early childhood, otherwise , there is no age bar.

SEX:- Female is higher risk than male.

RACE:- Very common in Jews and comparatively less common among Negroes.

ENVIRONMENTAL FACTOR
CLIMATE :- Dry and Dust Weather

SOCIO ECONOMIC STATUS :-

 Unhygenic living conditions


 Overcrowding
 Unsanitary conditions
 Abundant fly population
 Paucity of water
 Lack of materials like separate towels, handkerchief, and lack of education
 Understanding about spread of contagious disease
 Exposure to dust
 Smoke
 Irritants
 Sunlight
 Use of kajal or surma from the same container

Therefore outdoor workers are more affected in comparison to office.

INCUBATION PERIOD
(Time between becoming infected and developing symptoms)

Between 5 to 10 days , but most episodes of infection are reinfection and usually occur in
children who already have the disease.
Trichiasis usually takes many years to develop.

INFECTIOUS PERIOD
(Time during which an infected person can infect others)

Between 2 to 3 months, Trachoma is very infectious in its early stage and may be infectious on
and off as long as active infection persists.

MODES OF INFECTION
DIRECT SPREAD

Contact by air-borne or water-borne modes.

VECTOR TRANSMISSION

Through flies

MATERIAL TRANSFER

Through contaminated fingers of doctors, nurses and contaminated tonometers.

OTHER MATERIAL TRANSFER

Common towel, handkerchief, bedding and surma-rods

CLINICAL FEATURES:
Signs and Symptoms of trachoma usually affect both eyes and may include:

 Mild itching and irritation of the eyes and eyelids


 Eye discharge containing mucus or pus
 Eyelid swelling
 Light sensitivity (photophobia)
 Eye pain
 Eye redness
 Vision loss
 Corneal opacity
 Scarring
 Follicle

Young children are particularly susceptible to infection. But the disease progresses slowly, and
the more painful symptoms may not emerge until adulthood.

STAGES OF TRACHOMA (WHO):


The World Health Organisation(WHO) has identified five stages in the development
of trachoma.

 INFLAMMATION – FOLLICULAR:- The early infection has five or more follicle-


small bumbs that contain lymphocytes, a type of WBC- visible with magnification on the
inner surface of your eyelid (Conjuctiva).

 INFLAMMATION- INTENSE:- In this stage, eye is now highly infectious and


becomes irritated, with thickening or swelling of the upper eyelid.

 EYELID SCARRING:- Reapeted infections lead to scarring of the inner eyelid. The
scars often appear as white lines when examined with magnification. Eyelid may become
distorted and may turn in (entropin).

 IN TURNED EYELASHES (TRICHIASIS) :- The scarred inner lining of eyelid


continues to deform, causes eye lashes to turn in so that they rub on and scratch the
transparent outer surface of the eye (cornea).

 CORNEAL CLOUDING (OPACITY):- The cornea becomes affected by an


inflammation that is most commonly seen under the upper lid. Continuous inflammation
compounded by scratching from the in-turned lashes leads to clouding of the cornea.

LABORATORY DIAGNOSIS
Conjunctival Cytology.
Detection of inclusion bodies
Enzyme linked immunosorbent assay (ELISA) for chlamydial antigens.
Polymerase Chain Reaction (PCR) is also useful.
Giemsa iodine microscopy to detect incusions
Nucleic acid Amplification to detect DNA\RNA.
Fluoroscein microscopy to detect antigen.
Serology to test the human antichamydial antibody.

 The diagnosis is made by qualified Primary Health Care Staff (PHC)………Aboriginal


health workers, nurses and doctors..taking history and examining the eye. A swab of the
eye may be used to help the diagnosis but is not routinely required.

PREVENTION AND CONTROL


The WHO and the Communicable Disease Network Australia (CDNA) recommende the
SAFE strategy , 4 actions which aim to eliminate TRACHOMA:

 S- Surgery for Trichiasis


 A- Antibiotics (azithtromycin) for cases of active trachoma and their contacts.
 F- Facial cleanliness by promoting clean faces to reduce spread of infection
 E- Environmental improvements to improve overcrowding, water and sanitation
facilities.

OTHERS, PROPER HYGIENE PRACTICE INCLUDES:-

 Face washing and Hand washing.


 Fly control. Reducing fly populations can help eliminate a source of transmission.
 Proper waste management.
 Improved access to water.

TRACHOMA CONTROL PROGRAMME- Early diagnosis and treatment of trachoma


prevent blindness. This trachoma control programme was launched in 1963 & later on 1976. It
was merged with national programme for control of blindness. Trachoma associated blindness is
preventable blindness. Under this programme, mass campaign treatment with tetracycline is:

Imroving intake of Vitamin A in Diet.


Imroving personal hygiene.
Adequate & safe water supply.
Health education.

CONCLUSION

Trachoma is a very serious disease but it is yet to have a true care. Millions of people
around the world are blind because of Trachoma and nothing exists to fix their vision.
Although Trachoma is not fatal it is still serious problem that needs equally serious
attention.

Eradication of Trachoma through treatment would be a major breakthrough- the first


bacterial infection eliminated through public health treatment programs.

BIBLIOGRAPHY
 NEELAM KUMARI “A TEXT BOOK OF COMMUNITY HEALTH NURSING -1”,
PV PUBLISHERS, PAGE NO-195,196.
 SHYAMALA DMANIVANAN “TEXT BOOK OF COMMUNITY HEALTH
NURSING-1 FOR B.SC NURSING”,
CBS PUBLISHERS, PAGE NO-322, 323
 JONES BR. THE PREVENTION OF BLINDNESS FROM TRACHOMA. TRANS
OPTHALMOL SOC U.K 1975, APR;95(1):16-33

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