Trachoma

Trachoma

Trachoma

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
  1. Admission
  2. Isolation
  3. History taking
  4. Reassurance
  5. Observation : physical examination and specific examination
  6. Inform the ophthalmologist
  7. Investigations are done
  8. Medical history is taken
  9. 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

  1. Surgery is performed for in turned eyelids (entropion)
  2. Electrolysis: insertion of a probe into the follicle to pull it out.
  3. Cyrotherapy : Using cold freeze thaw to squeeze the follicle
  4. 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

  1. Acute pain: eye related to swelling of the lymph nodes, photophobia and inflammation.
  2. Disturbed Sensory Perception: Visual related to damage to the cornea.
  3. Risk for infection, the spread related to lack of knowledge.
  4. 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.

Preventive Measures

  • Avoid physical contact with a person suffering from trachoma
  • Personal cleanliness especially the face and hands
  • Washing hands and face frequently with soap and water
  • Keep separate towels, handkerchiefs, linens for each member of the family
  • Use latrines to dispose off faeces covered with lid
  • Avoid crowded places
  • Wash , hang , dry and iron all linens
  • Good hygiene during deliveries
  • Avoid eye makeup
  • Spray flies
  • clean compounds to keep away flies
  • Early diagnosis and treatment
Prevention ( SAFE) Strategy by WHO.
  • S= Surgery (Surgery for trchiasis/entropion/corneal opacity)
  • A=Antibiotics (Azithromycin 500mg single dose)
  • F= Facial cleanliness
  • E= Environmental Improvement.
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