TrachomaTrachoma

Our TeamOur Team Ahmed BarakatAhmed Barakat

Islam OsmanIslam OsmanAmgad AnisAmgad AnisAhmed AliAhmed Ali

ItemsItemsIntroductionIntroduction

Conjunctival manifestationsConjunctival manifestations

Corneal manifestationsCorneal manifestations

ComplicationsComplications

DiagnosisDiagnosis

TreatmentTreatment

TrachomaTrachoma is a chronic contagious kerato-conjunctivites . It is also named Egyptian OphthalmiaCausitive organism :Chlamydia trachomatis which has combined characters of viruses and bacteriaBacterial characters: -large size -contain both DNA and RNA -has cell wall -susceptible to Tetracyclin, Erythromycin and Sulphonamides -divide by SBF

Viral characters: -obligate intracellular organism -produce intracytoplasmic basopilic inclusion bodies in epithelium

Chlamydia include many serotypes. Types A , B , Ba and C cause trachoma.

Epidemology:Epidemology:-It is the greatest cause of preventable blindness in the world-It affects more than 400 million people worldwide-It is endemic in Egypt and affects more than 80% of population.

Mode of infection:Mode of infection:

-Through conjunctival discharge carried by infected fingers dust and flies -Common on low socioeconomic areas -Occures mainly in children and women

Pathology:Pathology: The organism is epitheliotropic. The

elementary body is composed of a core of DNA surrounded by a protein cover which enter the cell by endocytosis. Divides inside the cell .. The inclusion body is formed of many elementary bodies.. The cell ruptures discharging it’s contents of elementary bodies to infect new cells.The cycle takes about 24 hours.

History:History:Trachoma is one of the oldest known eye infections. It has a long story since 1500 B.C till now !!

- Ancient EgyptiansAncient Egyptians and Ebers papyrus Trachoma is Made in Egypt !! - Ancient Greece- Ancient Greece ..Trachoma means “rough eye”- Ibn ‘Isa Al-Kahhal- Ibn ‘Isa Al-Kahhal in the 11th century - French Occupation- French Occupation on Egypt then to Europe.- Immigration- Immigration toto America.America.- Detection- Detection of the inclusion bodies in 1905- Isolation- Isolation of Chlamydia trachomatis and culture on hen’s egg in 1957. - - EffectiveEffective trail of treatment by Sulpha,Tetracyclin

and Azithromycin.

Examination of travellers at

Ellis Island

Frightening Buttonhook !!Frightening Buttonhook !!

Conjunctival ManifestationsConjunctival ManifestationsMacCallan’s classification

Trachoma affects mainly upper plapepral conjunctiva.Trachoma affects mainly upper plapepral conjunctiva.Four stages: TI-TII-TIII-TIV.Four stages: TI-TII-TIII-TIV.TI : TI : Immature follicles, incipient stage. subepithelial small grayish white follicles formed of a centre of mononuclear cells surrounded by lymphocytes and giant multinucleated cells (Leber’s cells)(Leber’s cells)the follicles are not raised above the surface,non-expressible (like Grains of rice) TIIa :TIIa : mature follicles, established stageFollicles enlarge , become raised above the surface and expressible.TIIb :TIIb :papillaeformed of core of blood vessel and poliferating epitheluim papillae are soft ,vascular and pink in color.

TIII :TIII :Cicatrizing stagehealing occurs by cicatrization , which may take the form of lines ,patches or a dense white line at the sulcus subtarsalis (2mm from the lid margin) called Arlet’s lineArlet’s line

Degenration occurs in the conjunctival crypts between the papillae or in the deeper parts of the papillae forming what is called Post trachomatus degenerations PTDsPTDsCalcifecation may occur in some PTDs leading to formation of white hard spots called Post trachomatus concretions PTCsPTCs.The name!!..The major Complaint !!

TIV :TIV : Healing stagecomplete healing is the end point with no demarcation of follicles or papillaeNo inclusion bodies in conjunctival scraping..the patient is not infective.

LookLookImmature folliclesImmature follicles

Mature folliclesMature follicles

Mixed follicles Mixed follicles and papillaeand papillae

CicatrizationCicatrization

Arlet’s lineArlet’s line

PTDsPTDs

PTCsPTCs

• Definition

•Definition•Site•Fate

•Definition•Manifestations due to pannus•Fate

•Definition•Types•Characters

•Definition•Causes

•Definition

Complication of TrachomaComplication of Trachoma

1. Lid:• Ptosis• Trichiasis.• Cicatricial entropion.• Chronic meibomianitis.

2. conjunctiva:• Posterior symblepharon.• Xerosis.• Pigmentation.

Complication of TrachomaComplication of Trachoma

3. Lacrimal system:• Obstruction of puncti by fibrosis.

• Chronic canliculitis.

• Chronic dacryocystitis.

• Chronic dacryoadinitis.

4. Corneal complication : according to the stage.

WHO Classification of TrachomaWHO Classification of Trachoma

• TF: Trachomatous follicles.

• TI : Trachomatous inflammation.

• TS: Trachomatous scarring.

• TT: Trachomatous trichiasis.

• CO: Coreal Opacification.

Diagnosis of TrachomaDiagnosis of Trachoma

1. Clinical sure signs: expressible follicles , pannus , Arlt’s line, PTDs.

2. Intracytoplasmic basophilic inclusion bodies in conunctival scarpings stained with Giemsa stain.

3. Immunologic tests.Differential diagnosis:1. Follicular trachoma: from other causes of follicular

conjunctivitis.2. Papillary trachoma: from other causes of papillae

mainly spring catarrh.3. Trachomatous pannus from other causes of pannus.

Treatment Treatment

1.Medical :• Local : 1. Sulfonamide

2.Broad-spectrum antibiotic eye drops and ointment. eg. Tetracycline, erythromycin, chloramphenicol. For 6-12 weeks. 3. Atropine if cornea is involved.

• General: : 1. Sulfonamide 2.Broad-spectrum antibiotic. eg. Tetracycline

2. Surgical : must be used with medical treatment .• Expression of follicles.• Scarping of papillae.• Picking of PTDs.3. Treatment of complications

Vision 2020 (the right to sight )• A strategy referred to as "SAFE" (Surgery,

Antibiotic, Facial Cleanliness and Environmental Improvement) has been developed and is being applied in affected areas. It is expected that through the use of the SAFE strategy it will be possible to eliminate trachoma as a blinding disease by the year 2020.