Trachoma

Table of Contents

Trachoma is contagious infection of the conjunctiva and cornea characterized by formation of granulation and scarring

Trachoma is a contagious bacterial infection which affects the conjunctival lining covering of the eye, the cornea and the eyelids.
Is a Greek word meaning “ Roughness”

Etiology

Trachoma is caused by the Chlamydia trachomatis bacteria and is essentially preventable and curable.
It is the leading infectious cause of blindness in the world and it spreads very easily.

Predisposing Factors to Trachoma

Poor sanitation (lack of latrines, rubbish pit)
Unclean water supply/ even lack of water.
Living in dry and dusty environment.
Overcrowding with unhygienic conditions.
Reduced personal and community hygiene allow the bacteria to infect and reinfect the eyes of the individuals living in endemic areas.

Risk Factors of Trachoma

Dirty face
Improper hand hygiene
Ignorance about personal hygiene and environmental sanitation.
Inadequate housing and lack of functional housing
Crowded living conditions e.g. children sharing beds.
Poor water supply.
Swimming in water
Poor nutrition
Age
Occupation

Risks for Mode of Spread: 6D’s

Dry
Dusty
Dirty
Density
Dung
Discharge

Mode of Transmission: 5F’s

Fingers
Flies
Feaces
Face
Fomites

Incubation period

5- 21 days

Mode of infection

Direct spread (e.g. direct personal contact)
Vector transmission (e.g. bush fly, house fly)
Material transfer (e.g. shared towels clothes)

Clinical Features of Trachoma.

The signs and symptoms will depend on the presence/ absence of secondary infection, incase of a bacterial infection the signs resemble bacterial conjunctivitis.
Conjunctiva appears congested.
Irregular scarring of the conjunctiva
The cornea shows superficial keratitis
Later corneal opacity and corneal ulcer may occur.
Eye irritation
Redness and itching
Mucoid Discharge
Swelling of the eyelids
Inflammation inside the upper eyelid
Scarring of the upper lid
Distortion of the upper eyelid
Development of eyelashes that turns into the eye lid then rub on the cornea causing entropion
Abnormal growth of corneal blood vessels
Foreign body sensations
Stickiness of the lids
Keratitis
Conjunctival congestion
Herbert follicles and Herbert pits develop
Conjunctival scarring
Corneal ulcer
Corneal opacity

WHO classification of Trachoma (FISTO)

Trachomatis Follicular inflammation (TF)

This is an active phase of the disease at least with 5 or more follicles already forming in the upper margin and there size is larger than 0.5mm in diameter.

Trachomatis inflammation (TI)

The inflammation is very active with thickening of the upper conjunctiva.

Trachomatis Scarring: (TS)

- Trachomatis scarring in the tarsal conjunctiva seen as a white bands or threads of fibrosis.

Trachomatis trichiasis(TT)

When at least 1 eyelash rubs on the ocular surface. (atleast one trichiasis lash)

Trachomatis corneal opacity (C.O)

Corneal opacity: when there is visible corneal opacity in the eye pupillary area and a visual acuity less than 6/18

DIAGNOSIS :

History
Physical examination
Investigation: Pus swab

Management of Trachoma

Aims

To prevent spread
To Relieve symptoms
To prevent complications

Admission
Isolation
History taking
Reassurance
Observation : physical examination and specific examination
Inform the ophthalmologist
Investigations are done
Medical history is taken
Medical Treatment.

T= tetracycline

E = Erythromycin

S=Sulfacetamide

T= Topical

Medical management.

Topical application of antibiotics like 1% Tetracycline ointment 3 times daily for six weeks.
Erythromycin, azromycin eyedrops is instilled 4 times daily for six weeks.
Systemic steroids can be given to reduce the inflammation/congestion like predisolone or dexamethasone.
Alternatively doxycycline may be given for 2-3 weeks ( dose is given according to age of the patient).

Surgical management

Surgery is performed for in turned eyelids (entropion)
Electrolysis: insertion of a probe into the follicle to pull it out.
Cyrotherapy : Using cold freeze thaw to squeeze the follicle
Argon laser treatment: The follicle will be destroyed.

Nursing Care

Regular cleaning of the eyes
Disinfect equipments used
Ironing and cleaning linens
Encourage hand washing
Barrier nursing measures
Nutrients e.g. proteins and vitamins
Rest and sleep
Reassurance

Advice on discharge

Health education on environmental change
Drug compliance
Increase access to clean water and sanitation.

Nursing Diagnosis for Trachoma

Acute pain: eye related to swelling of the lymph nodes, photophobia and inflammation.
Disturbed Sensory Perception: Visual related to damage to the cornea.
Risk for infection, the spread related to lack of knowledge.
Body image disorders related to loss of vision.

Complications.

Trichiasis (inward growth of eyelashes that rub on the cornea, conjunctiva)
Entropion (eyelid rolled inward against eyeball by muscle spasm by scarring of the conjunctiva)
Keratitis(inflammation of the cornea)
Ptosis(abnormal low lying or drooping of the upper eyelid)
Secondary glaucoma
Corneal opacity, blindness.