View source for Trachoma

==Background==
[[File:Gray896.png|thumb|Anterior view of the right eye, with lacramal duct shown medial.]]
[[File:Gray894.png|thumb|The tarsi and their ligaments. Right eye; anterior view.]]
[[File:eyelid glands.png|thumb]]
*Most common cause of infectious blindness worldwide
*Caused by [[Chlamydia trachomatis]]
**Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals)
*More than 6 million blind secondary to trachoma and more than 150 million in need of treatment
*Typically affects most marginalized populations in the world
**Those with limited access to clean water and sanitation
**Part of the group of diseases known as [[neglected tropical diseases]]

==Clinical Features==
[[File:trachoma.jpg|thumbnail|[http://www.flickr.com/photos/communityeyehealth/5686867974/in/photolist-9yvAnR-9yvAf2-9yyAQw-9yyBq3-9yyB9Y-9EwFHQ-dW9VqU-dW4jzi-dW9Vqf-9yyBE1-9yvA22-9EtLZc-9wnCPz-fkvMSo-9yyAVm-dWa7P1-dWa7HU-dWa7mQ-9wqCPE-9wS7eH-dW4vt4-dWa7C7-dW4vNv-dW9VpW-dW4vnv-dWa7SL-dWa7Gw-dW4w8T-dWa7Vw-9yyAMU-dWa7e3-dWa7sQ-fofWkV-dW4vAD-dWa7zd-dW4vAH-9i9MxD-fkoX9y-9Ab3zW-cQSPYL-cXe39U-dhUoe1-9yvA88-9wV76Q-9yvAqM-pWqs-9hocNj-aBgF8w-9oSHXb-dWuo2J Trachoma Stages]]]
[[File:Corneal scarring trachoma.jpg|thumb|Corneal Scarring - End Stage Trachoma]]
===Acute===
*[[Conjunctivitis]]-like symptoms
**Conjunctival follicles (white lumps) on the inner upper eyelid
**Non-specific inflammation and thickening of the conjunctiva

===Chronic===
*Known as the "quiet disease" because of its slow chronic course
*Blindness after repeated infections
**Caused by structural changes to the inner eyelid
***Scarring of the inner eyelid that leads to buckling of the lid
****This causes the eyelashes to turn inwards (Trichiasis) and rub on the cornea causing repetitive trauma that leads to opacities and scarring of the cornea 
*Major complications include [[corneal ulcers]]

==Differential Diagnosis==

==Evaluation==
*Clinical diagnosis<ref>Solomon AW, et al. Trachoma. Nat Rev Dis Primers. 2022;8(1):32. PMID 35618795</ref>
====WHO classification====
*Simplified grading system composed of 5 clinical signs of infection
**Follicular trachomatous inflammation (TF)
***≥5 follicles >0.5mm on the superior tarsal conjunctiva
**Intense trachomatous inflammation (TI)
***Hypertrophy of the papilla and inflammatory thickening of the superior tarsal conjunctiva (must obscure more than half of the deep vessels)
**Trachomatous scarring (TS)
***Scarring in the superior tarsal conjunctiva
**Trachomatous trichiasis (TT)
***One or more ingrown eyelash in contact with the globe or evidence of eyelash loss (epilation)
**Corneal opacity
***Must blur part of the pupil margin

==Management==
*S.A.F.E. strategy proposed by WHO
**S - Surgery
***Bilamellar tarsal rotation procedure recommended by WHO
**A - Antibiotics
***Tetracycline 1% eye ointment
****Adherence issues secondary to difficulty in use and uncomfortable to apply
***[[Azithromycin]] (20mg/kg) single dose
****Relatively expensive in resource poor settings
**F - Facial cleanliness
***Helps decrease disease transmission
**E - Environmental management
***WHO emphasizes access to latrine and clean water

==Disposition==

==See Also==
*[[Parasites]]
*[[Travel Medicine]]
*[[Neglected Tropical Diseases]]
*[[Onchocerciasis (River Blindness)]]

==References==
*http://www.cdc.gov/healthywater/hygiene/disease/trachoma.html
*http://www.cartercenter.org/health/trachoma/index.html
*http://webcache.googleusercontent.com/search?q=cache:http://whqlibdoc.who.int/publications/2006/9241546905_eng.pdf
*http://www.who.int/topics/trachoma/en/

[[Category:ID]]
[[Category:Tropical Medicine]]