Trachoma

Archana Jeyaraj 015

Arogya Raj 016
Trachoma

 Trachoma comes from the Greek word for ‘rough’- surface appearance of conjunctiva in chronic trachoma
 It’s a chronic keratoconjunctivitis ,affecting the epithelium of conjunctiva and cornea simultaneously.
 Characterised by a-
1. mixed follicular and papillary response of conjunctival tissue
2. pannus formation
3. late stages- cicatrization
Etiology

 Causative organism – Chlamydia trachomatis, serovars A ,B , Ba and C are associated with hyperendemic
trachoma
 Predisposing factors –
1. Age- usually infancy/early childhood ; age no bar
2. Sex- preponderance in females
3. Race- very common in jews,less common in negroes
4. Climate- common in dry and dusty weather
5. Socioeconomic status- more common in poor classes,unhygienic living conditions
6. Environmental factors- exposure to dust,smoke,irritants and sunlight
 Source of infection- conjunctival discharge of affected person
 Modes of infection-
 Direct spread-airborne and waterborne
 Vector transmission-by flies
 Material transfer- contaminated fingers of doctors,tonometers,common towels
Clinical and pathological features

 Can be described into 2 phases –

PHASE OF ACTIVE INFLAMMATORY TRACHOMA
PHASE OF CHRONIC CICATRICIAL TRACHOMA
Phase of Active inflammatory trachoma

 Occurs usually during childhood

 Incubation period is from 7-14 days
 Onset of disease is usually insidious
Symptoms of active inflammatory trachoma
 SYMPTOMS-
In absence of secondary infections-
 Mild foreign body sensation
 Occasional lacrimation
 Slight stickiness of lids
 Scanty mucoid discharge
In the presence of other secondary bacterial infections
 Discomfort, foreign body sensation, grittiness, blurring and redness
 Mild photophobia
 Mucopurulent discharge
 Sticking of eyelids
 Slight blurring of vision
 Coloured halos
Conjunctival signs

 CONGESTION
 CONJUNCTIVAL FOLLICLES- seen on upper tarsal conjunctiva and fornix, sometimes seen in bulbar
conjunctiva
PATHOLOGICAL STRUCTURE OF FOLLICLE-
1. Scattered aggregation of lymphocytes in adenoid layer
2. Central part- mononuclear histiocytes,lymphocytes,leber cells(large and multinucleated)
3. Cortical part- zone of lymphocytes
4. Peripheral part- blood vessels present
 PAPILLARY HYPERPLASIA- reddish, flat topped raised, give red and velvety appearance
1. Central core- numerous dilated blood vessels
2. Surrounded by lymphocytes,covered by hypertrophic epithelium
Corneal signs

 SUPERFICIAL KERATITIS
 HERBERT FOLLICLES
 PROGRESSIVE PANNUS- infiltration of cornea associated with vascularisation in upper part
(infiltration of cornea ahead of vascularisation)
 CORNEAL ULCER
Phase of chronic cicatricial trachoma

 Manifests in middle age

Conjunctival signs

o Conjuctival scarring- irregular, star shaped, linear

Linear scar present in the sulcus subtarsalis is called ARLT’S LINE
o Concretions- hard looking whitish deposits varying from pinpoint to 2mmin size, accumulations of dead
epithelial cells, inspissated mucus in depressions called of henle
o Other sequelae- concretions, pseudocyst, xerosis and symblepharon
Corneal signs

 Regressive pannus
 Herbert pits- formed after healing of Herbert follicles
 Corneal opacity-present in upper part
 Corneal sequelae- cornea ectasia, corneal xerosis, total corneal pannus
 LID SIGNS- trichiasis,entropion,tylosis, ptosis, madarosis and ankyloblepharon
 LACRIMAL APPARATUS – chronic dacryocystitis,chronic dacryoadenitis
Grading of trachoma

 McCallan’s classification
STAGE I- incipient trachoma/stage of infiltration
STAGE II-established trachoma/florid infiltration
STAGE III-cicatrising trachoma/stage of scarring
STAGE IV-healed trachoma/stage of sequelae
 WHO Classification-FISTO
STAGE FEATURES

TF:Trachomatous Follicular inflammation

inflammation-follicular 5 or more follicles(each 0.5mm or more in diameter) on upper tarsal conjunctiva
Deep tarsal vessels should be visible through follicles and papillae

TI:Trachomatous Inflammatory thickening on upper tarsal conjunctiva

inflammation-intense

TS:Trachomatous scarring Presence of scarring,easily visible as white bands/sheets in tarsal conjunctiva

TT:Trachomatous trichiasis Atleast one eyelash rubs the eyeball

CO:Corneal opacity Corneal opacity present over pupil

Dense corneal scarring where pupil margin is blurred