1. Trachoma
Investigations and management

2. Diagnosis
• Clinical diagnosis : can be made by its typical
signs . clinical grading should be done as per
WHO classification into TF , TI , TS ,TT or CO.
• Lab diagnosis :
1. conjunctival cytology: giemsa stained
smears shows predominently PMN’s with plasma
cells and leber cells is suggestive of trachoma

3. 2. detection of inclusion body : conjunctival
smears by giemsa stain , iodine stain or
immunofluorescent staining especially in
case of active trachoma
3. ELISA : for chlamydial antigens
4. Isolation of chlamydia : is possible by yolk
sac inoculation and tissue culture techniques
5. Serotyping of TRIC agents is done by
detecting specific ab. Using micro
immunofluorescence method

4. Direct monoclonal fluorescent ab microscopy of
conjunctival smear is rapid and inexpensive
6. Polymerase reaction PCR : is also helpful

5. • Differential diagnosis
1. trachoma with follicular hypertrophy must be
differentiated from follicular conjunctivitis as
follows :
distribution of follicles in trachoma is mainly on
upper palpebral conjunctiva and upper fornix,
while in EKC lower palpebral conjunctiva and
lower fornix is involved
associated signs such as papillae and pannus
are characteristic of trachoma

6. 2. trachoma with predominant papillary
hypertrophy: needs to be differentiated from
palpebral form of spring catarrh as follows
papillaee are larger in size and usually there is
typical cobble- stone arrangement in spring
catarrh
ph of tears is usually alkaline in spring catarrh,
while in trachoma it is acidic
discharge is ropy in spiral catarrh
follicles and pannus may also be present in
trachoma
cytology and other lab tests for trachoma are
helpful in diagnosis

7. management
Includes both curative and control measures
A. TREATMENT OF ACTIVE TRACHOMA
1. ANTIBIOTICS : oral/systemic/topical
 cheaper
 no risk of systemic side effects
 also effective against bacterial conjunctivitis
Regimen includes:-
1. Topical tetracycline(1%) or erythromycin(1%)
oinment 4 times a day for 4 weeks. Or ,

8. 2. sulfacetamide(20%) eye drops 3 times a day
along with 1% tetracycline at bed time for 6
weeks.
systemic regimen:-
3. Tetracycline or erythromycin 250 mg orally, 4
times a day for 3-4 weeks or
Doxycycline 100mg orally twice daily for 3-4
weeks or,
Azithromycin 1gm stat or 250 mg od x 4 days . It
is presently considered the first drug of choice.

9. Combined topical and systemic therapy regimen:-
It is preferred when infection is severe or when
there is assosiated genital infection, includes
 tetracycline or erythromycin eye ointment 4
times a day for 6 weeks and
 tetracycline and erythromycin 250 mg orally 4
times a day for 2 weeks

10. B. Treatment of trachoma sequelae
 concretions should be removed with a
hyperdermic needle
Trichiasis may be treated by epilation,electrolysis
or cryolysis
Entropion should be corrected surgically
Xerosis should be treated by artificial tears

11. C. Prophylaxis for trachoma infection
Hygienic measures associated with personal
hygiene and
Environmental sanitation
Use of common towel, hankerchief, should be
discouraged
 early treatment of conjunctivitis cases reduces
transmission
 blanket antibiotic therapy (intermittent
treatment): to be carried out in endemic areas,
applies 1% tetracycline ointment twice daily for
5 days in a month for 6 months

12. Thank you