Trachoma is a contagious eye disease caused by the bacterium Chlamydia trachomatis. It is the world's leading cause of infectious blindness. Repeated infections during childhood can cause scarring of the inner eyelid and turn inward eyelashes (trichiasis) which scratches the cornea, causing opacity and eventual vision loss. The disease thrives in hot, dry, dusty conditions where personal and community hygiene is poor. Treatment focuses on the SAFE strategy of surgery, antibiotics, facial cleanliness, and environmental improvements to interrupt disease transmission.

1. Trachoma
-It is a contagious disease caused by gram
negative obligate intracellular bacteria
chlamydia trachomatis serotypes A, B and
C, Serotypes D-K are associated with
genital infection.
-Trachoma is a Greek word which means
rough which describes the appearance of
the surface of the conjunctiva.

2. • Trachoma is the world’s leading cause of infectious
blindness, an estimated 84 million people have
active trachoma and 7.6 million have trachomatous
trichiasis
• It is a disease of poor personal and community
hygiene, affecting those living in the poorest
condition, and disappears as living conditions
improve.
• Repeated or persistent infection with the obligate
intracellular bacteria Chlamydia trachomatis leads
to a blinding syndrome (trachoma)

3. • Trachoma progresses from inflammation of the
upper tarsal conjunctiva to scarring; distortion of
the eyelid causes trichiasis and eventual loss of
vision secondary to corneal opacity after which
blindness is essentially irreversible.
• Trachoma is common in the dry, hot, dusty climate
which stretches from north India, Middle East, to
North Africa and Sahel region of central and West
Africa.

4. • In Uganda it’s common in Kitgum, Kotido, Moroto,
Nakapiripiti, Gulu, mansindi, Nebbi, Pader, Lira
Busoga region, Tororo, Busia.
• Women and children 1-9yrs more affected
• Read about life cycle of chlamydia trachomatis

5. Pathophysiology
• Trachoma affects the epithelial cells of the conjunctiva
and sub epithelium tissue. Re-infection is associated
with severe inflammatory reactions resulting into sub
epithelial fibrosis and scarring.
• Risk factors for trachoma
• -Lack of adequate water
• -House fly
• -Cattle
• -Poor personal hygiene
• -Overcrowding

6. Risk factors for transmission
• 5Fs
• Flies
• Feaces
• Fingers
• Fomites
• Faces
5Ds
• -Density /over crowding
• -Dusty
• -Dryness
• -Dung
• -Discharge

8. • Clinical presentation
• Redness, eye discharge/mucopurulent discharge,
punctate keratitis
• Pannus
• Follicles 0.5-2mm/Papillae
• Herbert’s pits which are small dark dimples at the
limbus, when limbal follicles resolve leave behind ghost
pits
• Corneal scars
• Trichiasis
• Conjuctival scarring
• Floppy lid eyes/lid scarring
• Superficial punctate keratitis
• Watering due to lacrimal apparatus inflammation

9. • WHO classification of trachoma
• Trachoma with follicles (TF) there must at least 5
follicles of 0.5mm-2mm on the upper tarsal plate
but conjuctival vessels must be visible through the
follicles
• Trachoma intense (TI) there are many follicles ,50%
of the conjunctiva blood vessels cannot be seen.
• Trachomatous scarring (TS) white scars are present
on the upper tarsal plate.
• Trachomatous trichiasis (TT) some eyelashes
rubbing against the cornea
• Corneal opacities (CO) there are corneal opacities
affecting the central cornea and lowering the vision
to less than 6/18

16. SAFE strategy
• Surgery
• Antibiotics
-Mass treatment with antibiotics , -Azithromycin
-Tetracycline eye ointment 4times for 3 weeks
• Face washing
Environmental sanitation
-Pit latrine, and proper garbage dispose, Provision
of adequate amount water

19. Trachoma as public health problem
• TF (0-10YEARS OLD) >20%
• TI (0-10YEARS OLD) >5%
• TT (ADULT FEMALES) > 1%
• CO (ADULT FEMALES) <0. 1%