TRACHOMA

Presented to :
Dr. Maha Javaid
Presented by :

Ayesha Dua ( F19-079 )

Seerat Fatima (F19-080)
Hasban Allah (F19-081)
Muhammad Latif (F19-082)
Learning Objectives :

 Introduction

 Epidemiological Triad

 Mode of transmission

 Clinical Features

 Signs and Symptoms

 Diagnosis

 Prevention and Control

Introduction :

 Trachoma is a chronic infectious

disease of the conjunctiva and
cornea, caused by Chlamydia
trachomatis , but other
pathogenic microorganisms often
contribute to the disease.
Classification :

 Blinding Trachoma

 Non-blinding Trachoma
Incubation Period :

 5 to 12 days
 Epidemiology :

 Trachoma is a major preventable cause of blindness in developing countries.

 According to recent estimates, about 2.2 million people currently suffer from visual impairment due
to trachoma, of these 1.2 million are irreversibly blind, and about 324.85 million are at risk of
infection.

 The incidence and prevalence of trachoma has shown a significant decrease in many endemic
countries of SEAR during the past few decades.

 This decrease has been mainly due to improved sanitation, water and housing, and implementation
of control measures.

 However, trachoma, particularly in its active form, still remains a public health concern in some
parts of Myanmar, in the western region of Nepal and in a few rural areas in India.

 It is estimated to be responsible for 0.2 per cent of visual impairment and blindness in India
Epidemiological Triad :
Agent:
• C. Trachomatis

Host: Environment:
• Children • Season
• Both sexes • Quality of Life
• Customs
Agent Factors :
AGENT:

 The classical endemic trachoma of developing countries is caused by C. trachomatis of immune types A, B, or C.

 The sexually-transmitted C. trachomatis (serotypes D,E,E,G,H,I,J or K) may also infect, causing an eve disease
difficult to differentiate from endemic trachoma

 Milder cases of this are usually called "inclusion conjunctivitis".

 Other pathogenic organisms (e.g., Morax-Axenfeld diplobacillus, the Koch-Weeks bacillus, the gonococcus) often
contribute to the disease process.

 The Morax-Axenfeld diplobacillus is the most innocuos; the Koch-Weeks bacillus is the most widespread, and
the gonococcus the most dangerous

RESERVOIR:

 Children with active disease, chronically infected older children and adults.

SOURCE OF INFECTION:

 Ocular discharges of infected persons and fomites

Host Factors :
AGE:

 In endemic areas, children (2-5 years ) may show signs of the disease at the age of only a few months.

SEX:

 Prevalence equal in younger age groups.

 In older age groups, females have been found to be affected more than males.

PRE-DISPOSING FACTORS:

 Direct sunlight

 dust

 smoke

 irritants ( kajal or surma )

Environmental Factors :
 SEASON:

 Increased number of eye-seeking flies

 April-May

 July-September

 The higher temperature

 Rainfall

 QUALITY OF LIFE:

 poverty

 crowding

 ignorance

 poor personal hygiene

 squalor

 illiteracy

 poor housing

 CUSTOMS:

 kajal
 Mode of Transmission :

 Eye-to-eye transmission

 Eye-seeking flies (e.g., Musca. spp., Hippelatus spp.)

 Venereal transmission (sexually transmitted)

 Genetic transmission
Signs :

 Follicular hyperplasia

 Papillary hypertrophy

 Conjuctival scarring

 Corneal ulceration
Symptoms:
 Mild itching

 Irritation of eyes and eyelids

 Eye discharge

 Eyelid swelling

 Light sensitivity

 Eye pain

 Eye redness

 Vision loss
WHO Grading of Trachoma :

 TF = Trachoma Follicles

 TI = Trachomatous inflammation

 TS = Trachomatous conjuctival scarring

 TT = Trachomatous trichiasis

 CO = Corneal opacity
Complications :

 Entropion
 Trichiasis
 Corneal scarring
 Corneal opacity
 Dry eye
 Ptosis
 Partial or complete vision loss
Diagnosis :

Cases must have at least 2 of the following diagnostic criteria ;

 follicles on the upper tarsal conjunctiva

 limbal follicles or their sequelae, Herbert's pits

 typical conjunctival scarring (trichiasis, entropion)

 vascular pannus, most marked at the superior limbus

 Prevention and Control :

 Assessment of problem

 Chemotherapy

 Mass treatment

 Selective treatment

 Surgical correction

 Surveillance

 Health education

 Evaluation
 Assesment of the problem :

 Primary objective of programme for trachoma control is prevention of blindness

 Focus on communities with high prevalence of blinding trachoma is indicated by ;

•Corneal blindness

•Trachomatous trichiasis and entropion

•Moderate and severe Trachomatous inflammation

 Such communities have blindness rates of >0.5%

 Also required information on local conditions and existing resource

Chemotherapy :

 The Objective is to reduce severity, lower incidence

and decrease prevalence of trachoma in long run

 Antibiotic of choice 1% ophthalmic ointment or oily

suspension of tetracyclines

 Erythromycin and Rifampicin

 Two Types Of Treatment

• MASS TREATMENT

• SELECTIVE TREATMENT
 Mass Treatment :

 Blanket treatment

 Prevalence of moderate or severe trachoma is >5% in children under 10 years

 Application of 1% tetracycline ointment to all children

 Twice daily for 5 days each month for 6 consecutive months, or

 Once daily for 10 days each month for 6 consecutive months

 Erythromycin is alternative antibiotic

 Selective Treatment :

 In communities with low to medium prevalence

 The whole population at risk must be screened

for case finding

 Treatment is applied only to those with active

problem
 Surgical Correction :

 Individual with lid deformities such as ;

• trichiasis

• entropion

 Are actively sought out by surgical procedures

 Have immediate impact in preventing blindness

 Surveillance :

 Once control of blinding trachoma is achieved

 Provision must be made to maintain surveillance

 Since trachoma is a familial disease , whole family

should be under surveillance

 Health Education :

Mothers of young children should be target

 Measures of personal and community hygiene

 Permanent change in behaviour patterns and in environmental factors

 Final solution improvement of living conditions and quality of life

Safe Strategy :
The SAFE strategy emphasises to the health worker key points in the control of
trachoma and the prevention of blindness;

 S: Surgical correction of trichiasis

 A: Antibiotic treatment of trachoma

 F: Facial cleanliness

 E: Environmental changes (water and sanitation)

 Evaluation :

 Trachoma control programme must be evaluated at frequent intervals

 Effect of intervention can be judged by ;

 Changes in age-specific rates of active trachoma

 Changes in prevention of trichiasis and entropion

THANK YOU
….!!!