Trachoma: Difference between revisions
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==Background== | ==Background== | ||
[[File: | [[File:Gray896.png|thumb|Anterior view of the right eye, with lacramal duct shown medial.]] | ||
[[File: | [[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''' | *'''Most common cause of infectious blindness worldwide''' | ||
*Caused by Chlamydia trachomatis | *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) | **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 | *More than 6 million blind secondary to trachoma and more than 150 million in need of treatment | ||
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==Clinical Features== | ==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=== | ===Acute=== | ||
*Conjunctivitis like symptoms | *[[Conjunctivitis]]-like symptoms | ||
**Conjunctival follicles (white lumps) on the inner upper eyelid | **Conjunctival follicles (white lumps) on the inner upper eyelid | ||
**Non-specific inflammation and thickening of the conjunctiva | **Non-specific inflammation and thickening of the conjunctiva | ||
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***Scarring of the inner eyelid that leads to buckling of the lid | ***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 | ****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 | *Major complications include [[corneal ulcers]] | ||
==Diagnosis== | ==Differential Diagnosis== | ||
==Evaluation== | |||
*Clinical diagnosis | *Clinical diagnosis | ||
====WHO classification==== | ====WHO classification==== | ||
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***Must blur part of the pupil margin | ***Must blur part of the pupil margin | ||
== | ==Management== | ||
*'''S.A.F.E.''' strategy proposed by WHO | *'''S.A.F.E.''' strategy proposed by WHO | ||
**'''S''' - Surgery | **'''S''' - Surgery | ||
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**'''A''' - Antibiotics | **'''A''' - Antibiotics | ||
***Tetracycline 1% eye ointment | ***Tetracycline 1% eye ointment | ||
****''' | ****'''Adherence issues''' secondary to difficulty in use and uncomfortable to apply | ||
***Azithromycin (20mg/kg) single dose | ***[[Azithromycin]] (20mg/kg) single dose | ||
****Relatively expensive in resource poor settings | ****Relatively expensive in resource poor settings | ||
**'''F''' - Facial cleanliness | **'''F''' - Facial cleanliness | ||
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**'''E''' - Environmental management | **'''E''' - Environmental management | ||
***WHO emphasizes access to latrine and clean water | ***WHO emphasizes access to latrine and clean water | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
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*[[Onchocerciasis (River Blindness)]] | *[[Onchocerciasis (River Blindness)]] | ||
== | ==References== | ||
*http://www.cdc.gov/healthywater/hygiene/disease/trachoma.html | *http://www.cdc.gov/healthywater/hygiene/disease/trachoma.html | ||
*http://www.cartercenter.org/health/trachoma/index.html | *http://www.cartercenter.org/health/trachoma/index.html | ||
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[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Tropical Medicine]] | ||
Latest revision as of 21:51, 23 October 2024
Background
- 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
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
- Scarring of the inner eyelid that leads to buckling of the lid
- Caused by structural changes to the inner eyelid
- Major complications include corneal ulcers
Differential Diagnosis
Evaluation
- Clinical diagnosis
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
- Follicular trachomatous inflammation (TF)
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
- Tetracycline 1% eye ointment
- F - Facial cleanliness
- Helps decrease disease transmission
- E - Environmental management
- WHO emphasizes access to latrine and clean water
- S - Surgery