UNIVERSITY OF CALABAR TEACHING HOSPITAL

DEPT. OF OPHTHALMOLOGY
OPTOMETRY UNIT
A SEMINAR PRESENTATION ON

BY
DR HOGAN OBICHERE
(INTERN OPTOMETRIST)

30TH JUNE 2021

OUTLINE
 Background
 Epidemiology
 Aetiology/Risk factors
 Clinical presentation
 Grading/Classification
 Diagnosis
 Differential Diagnosis
 Management
 Prevention
 Long Term Monitoring
 Case Study
 Take Home
 References
BACKGROUND
 Trachoma is the world’s leading infectious cause of blindness. This disease causes a chronic
keratoconjunctivitis resulting from the GRAM -VE obligate intracellular bacterium 
Chlamydia trachomatis. 

 C trachomatis can be spread by either direct or indirect contact

 Poor sanitation, crowded living conditions, and insufficient clean water and toilets can also
increase the spread of trachoma.

 Trachoma infection can be active, cicatricial.

 The World Health Organization (WHO) and their partners endorse the Surgery, Antibiotics,
Facial cleanliness, and Environmental improvement (SAFE) strategy for trachoma control.  
EPIDEMIOLOGY “WHO Blinding Trachoma Fact sheet N°382“, (2013).
 Trachoma was once endemic in North America and Europe

 Trachoma is endemic in parts of Africa, Asia, the Middle East, Latin America

 Worldwide, an estimated 229 million people in 53 countries live in trachoma-endemic areas

 A Population-based survey by Rabiu et al., 2011 across several states of

northern Nigeria later reaffirmed that trachoma of public health concern indeed exist
in Nigeria.

 The prevalence of the disease is in the range 0.6%-17.6% for Trichiasis and 5%-49% for
active trachoma across the trachoma belt of Nigeria (Rabiu et al., 2011).

 No studies have detected any prevalence of active trachoma in the southern part of Nigeria
Middle East Afr J Ophthalmol
. 2011 Apr-Jun; 18(2): 115–122.
doi: 10.4103/0974-9233.80699
CLINICAL PRESENTATION
 Two phases of the disease process exist: the active phase and the scarring (cicatricial) phase. 
 ACTIVE PHASE
 The active phase resembles many other diseases in which follicular conjunctivitis is a feature
 Most patients with active trachoma are relatively asymptomatic.
 characterized by a mucopurulent keratoconjunctivitis

 CICATRICIAL PHASE
 The cicatricial phase has unique clinical features, which lead to definitive diagnosis in most
cases.
 Conjunctival scarring alone tends to be asymptomatic, though the associated disturbance of
the architecture of the tear film
 Trichiasis causes an intensely irritating foreign body sensation, as well as blepharospasm.
 Leads to corneal scarring.
 Many patients self-epilate at this point
 Corneal opacities or scars impair the patient's vision.
WHO
CLASSIFICATION/GRADING (T.F.
)

Images from the Slides/Text Teaching Series, No. 7, Trachoma,

published by The International Centre for Eye Health, Institute of
Ophthalmology, 11-43 Bath St, London EC1V 9EL, United
Kingdom. Photograph courtesy of John D. C. Anderson, MD.
Trachomatous
(T.I.
inflammation
)
Trachomatous inflammation,
intense (TI) is pronounced
inflammatory thickening of
the upper tarsal conjunctiva
that obscures more than one Images from the Slides/Text Teaching Series, No. 7,
Trachoma, published by The International Centre for Eye
Health, Institute of Ophthalmology, 11-43 Bath St,
half the normal deep tarsal London EC1V 9EL, United Kingdom. Photograph
courtesy of John D. C. Anderson, MD.

vessels.
Trachomatous
Scarring (T.S.
presence of easily visible)scars in the
 Trachomatous scarring is defined as the

tarsal conjunctiva.

 Trachomatous scarring indicates past

inflammatory disease and a risk of
future trichiasis. The more severe the
scarring, the higher the risk of
subsequent trichiasis.

 This form may be associated with the Images from the Slides/Text Teaching Series, No. 7, Trachoma,
published by The International Centre for Eye Health, Institute of
development of dry eye syndrome Ophthalmology, 11-43 Bath St, London EC1V 9EL, United Kingdom.
Photograph courtesy of John D. C. Anderson, MD.
Trachomatou
s Trichiasis (T.T.
)
 Trachomatous trichiasis (TT) is defined
as the presence of at least 1 eyelash
rubbing on the eyeball or evidence of
recent removal of in-turned lashes.
 This is a potentially blinding lesion that
can lead to corneal opacification.
 Trichiasis is due to subconjunctival
fibrosis over the tarsal plate that leads
to lid distortion. Images from the Slides/Text Teaching Series, No. 7, Trachoma, published
 Some vision can be restored with the by The International Centre for Eye Health, Institute of Ophthalmology,
11-43 Bath St, London EC1V 9EL, United Kingdom. Photograph
successful correction of trichiasis. courtesy of John D. C. Anderson, MD.
Trachomatous
Corneal (T.O.
Opacity )
Easily visible corneal opacity over the
pupil; it is so dense that at least part of
the pupil margin is blurred when
viewed through the opacity. 

This condition includes pannus, epithelial

vascularization, and infiltration only if it
involves the central cornea
Images from the Slides/Text Teaching Series, No. 7, Trachoma, published
by The International Centre for Eye Health, Institute of Ophthalmology,
11-43 Bath St, London EC1V 9EL, United Kingdom. Photograph
courtesy of John D. C. Anderson, MD.
Differential Diagnoses

 Allergic Conjunctivitis
 Bacterial Conjunctivitis
(Pink Eye)
 Neonatal Conjunctivitis
(Ophthalmia Neonatorum)
 Trichiasis
 Viral Conjunctivitis (Pink
Eye)
Trachoma Allergic Conjunctivitis
Images from the Slides/Text Teaching Series, No. 7, Trachoma, published
by The International Centre for Eye Health, Institute of Ophthalmology,
11-43 Bath St, London EC1V 9EL, United Kingdom. Photograph
courtesy of John D. C. Anderson, MD.
Prevention and
Management
("WHO | Blinding trachoma”, 2015)
Surgical Care

 Eyelid surgery to correct trichiasis is important in people with

trichiasis, who are at high-risk for trachomatous visual impairment
and blindness.

 Eyelid surgery to correct entropion and/or trichiasis may prevent

blindness in individuals at immediate risk.

 Eyelid rotation limits the progression of corneal scarring. In some

cases, it can result in a slight improvement in visual acuity, probably
due to restoration of the visual surface and reductions in ocular
secretions and blepharospasm.
Antibiotics
Long Term Monitoring

 Long-term, intermittent follow-up care is required for patients with active or cicatricial
disease.

 One episode of infection may be treated adequately, but reinfection from the community
pool of infection is likely unless an effective mass treatment campaign is implemented.

 When mass treatment is undertaken, antibiotic coverage should be as high as possible, with
80% being an absolute minimal target. It is important to treat all family members,
especially the younger children.

 Some studies suggest a great benefit if coverage in excess of 95% can be achieved.

 Surgical patients require annual follow-up care because of the potential for recurrence.
("WHO | Blinding trachoma”, 2015)
 Case Presentation
Patient is a 24-year-old female who presented to the hospital. The face was dirty, and she was
generally in a poor state of hygiene

C.C: Loss of vision, painful eyes, tearing, headache, foreign body and pricking sensation in her
eyes which had been there for more than eight years.

Dem: The patient was the eighth and last-born child, residing in an overcrowded poor sanitation
housing condition.

H. Hx: No systemic ill-health FMHX: No history of medical conditions in the family

V.A: Light perception in both eyes. ALLERGIES: No known Allergies
FOVHx: No history of eye conditions in the family MEDICATION: Not on any medication

Slit Lamp Biomicroscopy: Entropion, turned in eye lashes touching the globe mucopurulent
discharge, upper tarsi scaring, cornea opacities in both eyes, hyper photosensitivity and failure
to open her eyes.
 Case Presentation
Treatment:
 She received her trachoma surgery after sedation with Diazepam intravenously.

 Both eyes were operated in one sitting.

 Local anaesthesia (lignocaine 2% with Adrenaline) was then infiltrated in her eyelids.

 Posterior Lamellar Tarsal Plate Rotation (Trabut) was successfully performed.

 After surgery, tetracycline eye ointment was applied in both eyes and thereafter padded
for 24 hours.

 Painkillers were given to her and the following day the eye pads were removed.

 On her first day post operatively, her visual acuity improved to hand movements.

 One week follow up was done and her visual acuity was 6/36 in both eyes.
Take Home

 The optometrist can diagnose trachoma through a physical examination of the tarsal plate
for follicles and by sending a sample of bacteria from ocular secretions to the lab where
possible to rule out differentials.

 An optometrist can treat trachoma depending on the stage of the disease.

 In the early stages of trachoma, treatment with antibiotics alone may be enough to
eliminate the infection.

 In the later stages of the disease, starting from Trachomatous Trichiasis, the optometrist
should refer immediately for a surgical repair of the tarsal plate to avoid cornea scaring.
 References
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Lancet. 2010 Jan 16. 375(9710):231-8. [Medline].

"Blinding Trachoma Fact sheet N°382". World Health Organization. November 2013. Archived from the original on 14 March 2014. Retrieved 14
March 2014.

Bobo LD, Novak N, Munoz B, Hsieh YH, Quinn TC, West S. Severe disease in children with trachoma is associated with persistent Chlamydia
trachomatis infection. J Infect Dis. 1997 Dec. 176(6):1524-30. [Medline].

Kalua K, Chirwa T, Kalilani L, Abbenyi S, Mukaka M, Bailey R. Prevalence and risk factors for trachoma in central and southern Malawi. PLoS One.
2010 Feb 5. 5(2):e9067. [Medline]. [Full Text].

Rabiu, M. M., Muhammed, N., & Isiyaku, S. (2011). Challenges of trachoma control: an assessment of the situation in northern Nigeria. Middle
East African journal of ophthalmology, 18(2), 115–122. https://doi.org/10.4103/0974-9233.80699

Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR. A simple system for the assessment of trachoma and its complications. Bull World Health
Organ. 1987. 65(4):477-83. [Medline]. [Full Text].

West SK, Munoz BE, Mkocha H, Gaydos C, Quinn T. Risk of Infection with Chlamydia trachomatis from Migrants to Communities Undergoing Mass
Drug Administration for Trachoma Control. Ophthalmic Epidemiol. 2015 Jun. 22 (3):170-5. [Medline].

"WHO | Blinding trachoma: Progress towards global elimination by 2020". 10 April 2006. Archived from the original on 8 July 2015. Retrieved 5
August 2015.