Trachoma

🦠 Trachoma

🔍 Definition

Trachoma is a chronic keratoconjunctivitis caused by Chlamydia trachomatis (serotypes A, B, Ba, and C). It primarily affects children but leads to blindness in adulthood due to repeated infections.

It is the leading infectious cause of blindness worldwide. 🌍

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🧬 Cause

• Bacteria: Chlamydia trachomatis (obligate intracellular organism)

• Serotypes: A, B, Ba, C

• Spread by:

  • Direct contact (hands, towels, eye secretions)

  • Flies (esp. Musca sorbens)

  • Poor hygiene, overcrowded living conditions

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👁️ Stages / WHO Classification (Simplified)

Stage	Description
TF (Trachomatous Inflammation – Follicular)	≥5 follicles on upper tarsal conjunctiva
TI (Trachomatous Inflammation – Intense)	Intense thickening of upper conjunctiva, obscuring vessels
TS (Trachomatous Scarring)	Conjunctival scarring from chronic inflammation
TT (Trachomatous Trichiasis)	Inturned eyelashes rubbing cornea
CO (Corneal Opacity)	Corneal scarring → blindness

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🔄 Progression of Disease

1. Repeated infections in childhood → chronic inflammation

2. Leads to conjunctival scarring

3. Causes entropion and trichiasis

4. Trichiasis leads to corneal abrasion, ulceration, and opacification

5. Ends in irreversible blindness if untreated

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📋 Symptoms

• Recurrent redness and discharge

• Itching, irritation

• Foreign body sensation

• Photophobia

• Blurry vision (in late stage)

• Pain (from trichiasis and corneal involvement)

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🔍 Signs

• Follicles on upper tarsal conjunctiva (esp. in children)

• Conjunctival papillary hypertrophy

• Scarring and white lines (Arlt’s line)

• Trichiasis (misdirected lashes)

• Corneal vascularization and opacity

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🔬 Diagnosis

Method	Description
Clinical examination	Based on WHO grading system
Giemsa stain	Shows inclusion bodies
PCR / NAAT	Detects chlamydial DNA
Serologic tests	Not commonly used for active disease

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💊 Treatment – The SAFE Strategy (WHO)

Letter	Stands for	Purpose
S	Surgery	For trichiasis (lashes turning in)
A	Antibiotics	Mass treatment to reduce community load
F	Facial cleanliness	Reduces transmission
E	Environmental improvement	Better sanitation, reduce fly breeding

💊 Antibiotic Regimen:

• Azithromycin 20 mg/kg (single oral dose) – preferred by WHO

• OR Topical tetracycline 1% ointment – twice daily for 6 weeks

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⚠️ Complications

• Trichiasis → corneal abrasions

• Corneal ulceration and opacification

• Blindness

• Psychosocial impact due to vision loss

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🌍 Epidemiology

• Endemic in parts of Africa, Middle East, Asia, Latin America

• Most common in children (active disease) and adult women (complications)

Females are 2x more likely to be blind due to trachoma because of repeated exposure from childcare.

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🧠 Quick Recap Table

Feature	Details
Cause	Chlamydia trachomatis (A, B, Ba, C)
Affects	Children (active), adults (blindness)
Symptoms	Redness, discharge, photophobia, pain (late)
Main complications	Trichiasis → corneal opacity → blindness
Treatment	SAFE strategy
Prevention	Hygiene, clean water, reduce crowding, fly control