Trachoma

Investigations and management

Diagnosis

• Clinical diagnosis : can be made by its typical signs . clinical grading should be done as per WHO classification into TF , TI , TS ,TT or CO.

• Lab diagnosis : 1. conjunctival cytology: giemsa stained

smears shows predominently PMN’s with plasma cells and leber cells is suggestive of trachoma

2. detection of inclusion body : conjunctival smears by giemsa stain , iodine stain or immunofluorescent staining especially in case of active trachoma

3. ELISA : for chlamydial antigens

4. Isolation of chlamydia : is possible by yolk sac inoculation and tissue culture techniques

5. Serotyping of TRIC agents is done by detecting specific ab. Using micro immunofluorescence method

Direct monoclonal fluorescent ab microscopy of conjunctival smear is rapid and inexpensive

6. Polymerase reaction PCR : is also helpful

• Differential diagnosis 1. trachoma with follicular hypertrophy must be

differentiated from follicular conjunctivitis as follows :

distribution of follicles in trachoma is mainly on upper palpebral conjunctiva and upper fornix, while in EKC lower palpebral conjunctiva and lower fornix is involved

associated signs such as papillae and pannus are characteristic of trachoma

2. trachoma with predominant papillary hypertrophy: needs to be differentiated from palpebral form of spring catarrh as follows

papillaee are larger in size and usually there is typical cobble- stone arrangement in spring catarrh

ph of tears is usually alkaline in spring catarrh, while in trachoma it is acidic

discharge is ropy in spiral catarrh follicles and pannus may also be present in

trachoma cytology and other lab tests for trachoma are helpful

in diagnosis

managementIncludes both curative and control measuresA. TREATMENT OF ACTIVE TRACHOMA 1. ANTIBIOTICS : oral/systemic/topical cheaper no risk of systemic side effects also effective against bacterial conjunctivitis Regimen includes:-1. Topical tetracycline(1%) or erythromycin(1%)

oinment 4 times a day for 4 weeks. Or ,

2. sulfacetamide(20%) eye drops 3 times a day along with 1% tetracycline at bed time for 6 weeks.

systemic regimen:-3. Tetracycline or erythromycin 250 mg orally, 4

times a day for 3-4 weeks or Doxycycline 100mg orally twice daily for 3-4

weeks or, Azithromycin 1gm stat or 250 mg od x 4 days . It is

presently considered the first drug of choice.

Combined topical and systemic therapy regimen:-

It is preferred when infection is severe or when there is assosiated genital infection, includes

tetracycline or erythromycin eye ointment 4 times a day for 6 weeks and

tetracycline and erythromycin 250 mg orally 4 times a day for 2 weeks

B. Treatment of trachoma sequelae

concretions should be removed with a hyperdermic needle

Trichiasis may be treated by epilation,electrolysis or cryolysis

Entropion should be corrected surgicallyXerosis should be treated by artificial tears

C. Prophylaxis for trachoma infection

Hygienic measures associated with personal hygiene and

Environmental sanitation Use of common towel, hankerchief, should be

discouraged early treatment of conjunctivitis cases reduces

transmission blanket antibiotic therapy (intermittent

treatment): to be carried out in endemic areas, applies 1% tetracycline ointment twice daily for 5 days in a month for 6 months

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