Trachoma is a bacterial infection that is the leading cause of preventable blindness worldwide. It is caused by Chlamydia trachomatis and spreads through direct contact or indirect contact with infected eye discharge or flies. Early symptoms include eye irritation and discharge, while later complications include scarring of the eyelid and turn inward of eyelashes (trichiasis) which can lead to corneal damage and blindness. Treatment involves antibiotics like tetracycline or azithromycin, while prevention relies on facial cleanliness, fly control, sanitation and hygiene practices. The SAFE strategy of surgery, antibiotics, facial cleanliness and environmental improvement aims to eliminate trachoma by 2020.

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2. TRACHOMA
By: Sumayya Naseem
Internee Optometrist

3. What is trachoma?
• Trachoma (Ancient Greek: "rough eye")
• Trachoma is the leading infectious cause of blindness
worldwide. In the poorest countries in Africa, prevalence
among children can reach 40 percent. The World Health
Organization (WHO) estimates that 8 million people
worldwide have been visually impaired by trachoma.
• Trachoma is a preventable cause of blindness and, if
treated early, the prognosis for people with trachoma is
excellent.
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4. Causes
• Trachoma is caused by the bacterium
Chlamydia trachomatis And it is spread by:
• Direct contact with eye discharge
• Fomites such as towels and/or cloths
• Poor personal and family hygiene.
• Lack of water
• Absence of latrines or toilets
• Poverty in general
• Flies
• Close proximity to cattle
• Crowding
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7. 5 F’s & 5 D’s
5 F’s 5 D’s
Flies Discharge
(eyes)
Filth Dust
(dirt, waste)
Faeces Dryness
(human)
Fingers Dung
(animals)
Fomites Density
(handkerchief, pillow) (over crowding) #

8. Symptoms
• Mild itching and irritation of the eye
• Watering
• Mucopurulent Discharge from the eye
As the disease progresses, later trachoma symptoms include:
• Marked light sensitivity (photophobia)
• Blurred vision
• Eye pain
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9. Signs
Conjunctiva:
• Follicular conjunctivitis (tarsal conj, fornices)
• Conjunctival scarring
• Limbal follicles
• Herbert's pits (after resolution of follicles)
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10. Normal Tarsal Conjunctiva
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11. Follicular Conjunctivitis
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12. Trachomatous Inflammation
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13. Conjunctival Scarring
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14. Herbert’s Pits
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15. Cornea:
• Keratitis (corneal ulcer)
• Corneal opacity (end stage)
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16. Corneal Opacity
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17. Lids:
• Entropion
• Trichiasis
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18. Trichiasis
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19. Entropion
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20. WHO Grading (FISTO)
• TF trachomatous follicles (5 sub tarsus)
• TI trachomatous inflammation (50% tarsal
vessels covered)
• TS trachomatous scarring
• TT trachomatous trichiasis
• CO corneal opacity
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21. Clockwise from top left: follicles of trachoma (TF), intense
inflammation of trachoma (TI), trichiasis of trachoma (TT),
Conjunctival scarring of trachoma (TS)
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22. Complications
• Scarring of the inner eyelid
• Entropion
• Trichiasis
• Corneal scarring or cloudiness
• Partial or complete vision loss
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24. Treatment
• Tetracycline, topical (2 months) and oral (3 weeks)
• Oral azithromycin
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25. Prevention
Proper hygiene practices, which include:
• Face washing. (especially children's)
• Controlling flies.
• Proper waste management.
• Properly disposing animal and human waste can
eliminate breeding grounds for flies.
• Improved access to water.
• Improved sanitation and living conditions.
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27. SAFE Strategy
• Surgery for correction of trichiasis
• Antibiotics
• Face cleaning
• Environmental improvement
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29. Some Important Terms
• Follicles:
These are enlarged nodules of lymphoid tissue under the
Conjunctival epithelium (fornix & tarsal conj.).
• Herbert’s Pits:
Follicles may occur at limbus, become scarred and shrink to
form little pits. These are called Herbert's pits.
• Entropion:
Severe scarring of the tarsal conjunctiva distorts the eyelid, So,
the margin of the eyelid turns inwards against the eyeball. This
is called entropion.
• Trichiasis:
Misdirected eyelashes (inward turned)
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