Trachoma

It is a form of conjunctivitis that is infectious. Trachoma, which means "rough eye" in ancient Greek and refers to the conjunctiva's outside appearance, primarily affects the cornea and conjunctiva at the same time. the second-most frequent cause of blindness after cataracts and the most common preventable disease.

Etiology

• Causative agent: Chlamydia trachomastis; bacteria that has the characteristics of a virus as well.

• Predisposing factors:

  • Age: generally contracted during infancy and early childhood period

  • Gender: Females are more affected

  • Climate: Common in dry and dusty weather

  • Socio-economic status: The disease is more common in the poor class, having unhygienic living conditions.

Risk factor for Trachoma

• Poverty

• Crowded living conditions

• Poor sanitation

• Age: mostly common in 3-5 yrs of children

• Sex: women contract the disease at higher rates than men.

• Poor access to water

• Flies

• Lack of latrines

Mode of Infection

• Direct spread: Direct contact with eye, nose, and throat secretions from affected individuals.

• Indirect transmission: Commonly through flies.

• Material transmission: Contact with fomites, such as towels and washcloths, bleedings that have had similar contact with this secretion.

• Incubation period of 5 to 12 days

Clinical presentation

• Symptoms are mild like foreign body sensation in the eye, occasional lacrimation, stickiness of the eyelids and scanty discharge.

• The conjunctival inflammation is called “active trachoma” and usually is seen in children, especially preschool children.

• Characterized by white lumps in the undersurface of the upper eyelid (conjunctival follicles). Follicles may also appear at the junction of the cornea and the sclera (limbal follicles)

• Active trachoma will often be irritating and have a watery discharge. bacterial secondary infection may occur and cause a purulent discharge.

• Blinding trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva.

Diagnosis

Laboratory diagnosis of trachoma includes:

• Conjunctival cytology: Giemsa-stained smears showing a predominantly polymorphonuclear reaction and a presence of plasma cells and Leber cells are suggested of trachoma.

• Detection of inclusion bodies: it is found in conjunctival smears may be possible by the Giemsa stain, iodine stain or immune-fluorescent staining especially in case with active trachoma

• Isolation of chlamydia is possible by yolk sac inoculation method and tissue culture technique.

The clinical diagnosis of trachoma is made from its typical signs; at least two sets of signs should be present out of the following.

• Conjunctival follicles and papillae

• Pannus progressive or regressive

• Epithelial keratitis

• Signs of cicatrization or its sequelae

Treatment

• Topical antibiotic therapy for 3-4 weeks

  • 1% tetracycline

  • 1% erythromycin

  • Sulphonamide eye drops

• Systemic therapy: tetracycline and erythromycin orally 3-4 wks combined.

Prevention

Use of handkerchiefs and common towels should be avoided, as should other hygienic practices.

Nursing Intervention

• Isolation of the patient: since it is highly contagious, prevention of the use of common clothing.

• Good personal hygiene: proper hand washing of the eyes daily.

• Emphasis on environmental sanitation: clean water, latrines, control of flies.

• Teach the patient and family correct way of instillation of drops and ointments.

• Observe closely for complication and inform physician.

Complication

• Entropion

• Trichiasis

• Chalazion formation

• Symblepharon

• Xerosis

• Corneal opacities and corneal ulcer

• Nasolacrimal duct obstruction

• Dacryocystitis

• Pseudoptosis

• Corneal perforation and blindness

Prevention

• Face washing

• Controlling flies

• Proper waste management

• Improved access to water- having a fresh water source nearby can help improve hygiene conditions.