Antibiotics, in conjunction with facial cleanliness campaigns and environmental improvements targeted at communities at risk, aim to reduce the reservoir of infection within a population.
Occurs predominantly in children. Poor facial cleanliness may be the most important modifiable risk factor in children who develop trachoma.
Children who have had multiple or severe episodes of active trachoma may develop cicatricial disease in later life.
Trachomatous cicatricial disease is characterised by tarsal conjunctival scarring, predominantly of the upper lid, although scarring may be sub-epithelial and not always patent. It may ensue over the subsequent decades and can lead to trachomatous trichiasis (the contact of 1 or more lashes on any part of the globe), corneal opacity, and subsequent loss of vision.
Prompt surgery must be offered to all patients who have trichiasis in order to prevent blindness.
Trachoma is a keratoconjunctivitis caused by ocular infection withChlamydia trachomatis(serovars A, B, Ba, and C). Inflammatory episodes in adults tend to be shorter and less severe than in children. Repeated infections lead to recurrent episodes of chronic inflammation that may progress to scarring of the upper tarsal conjunctiva. The scarring results in distortion of the upper eyelid, and this can cause lashes to turn inwards and abrade the cornea. This is called trachomatous trichiasis and, unless surgically corrected, will rapidly lead to corneal opacity and blindness.
Chlamydial conjunctivitis caused by the sexually transmitted strains of C trachomatis (serotypes D to K) is a separate, self-limiting infection.
History and exam
Key diagnostic factors
- presence of risk factors
- subtarsal (beneath the eyelid) conjunctival inflammation
- subtarsal follicles
- subtarsal conjunctival scarring
- trichiasis (the contact of 1 or more lashes on any part of the globe)
- corneal opacification and visual loss
- Herbert's pits (small pits around the margin of the cornea)
Other diagnostic factors
- ocular and nasal discharge
- red eye
- painful watery eye
- limbal (at the border of the cornea and sclera) follicles
- pannus (vessels growing over the clear cornea)
- children (active infection)
- poor facial hygiene
- female sex
- poor community hygiene
- residence in or emigration from an endemic area
1st investigations to order
- clinical diagnosis
Investigations to consider
- polymerase chain reaction (conjunctival swab)
- point-of-care conjunctival swab dipstick test
resource-poor endemic area: based on prevalence of active trachoma
resource-rich non-endemic area: infected individual and family contact
resource-poor endemic area: trachomatous trichiasis
resource-rich non-endemic area: trachomatous trichiasis
Van Charles Lansingh, MD, PhD
Help Me See Chief Medical Officer
Director of International Relations
IMO (Mexican Institute of Ophthalmology)
Santiago de Queretaro
VCL declares that he has no competing interests.
Kelly Callahan, MPH
Trachoma Control Program
The Carter Center
KC declares that she has no competing interests.
Paul Emerson, PhD, MSc
International Trachoma Initiative
PE declares that he has no competing interests.
Dr Van Charles Lansingh, Ms Kelly Callahan, and Dr Paul Emerson wish to gratefully acknowledge Dr Heathcote R. Wright and Dr Hugh R. Taylor, previous contributors to this topic. HRW and HRT are authors of a number of references cited in the topic.
Matthew Burton, BChir
International Centre for Eye Health
London School of Hygiene and Tropical Medicine
MB declares that he has no competing interests.
Victor Perez, MD
Miller School of Medicine
Bascom Palmer Eye Institute
University of Miami
VP declares that he has no competing interests.
- Chlamydial inclusion conjunctivitis
- Viral conjunctivitis
- Bacterial conjunctivitis
- National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, third edition
- Trachoma control: a guide for programme managers
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