Conjunctiva

Trachoma

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Trachoma, Cicatricial Trachoma, Trachoma Inclusion Conjunctivitis

  • See Also
  1. Chlamydial Conjunctivitis
  2. Bacterial Conjunctivitis
  3. Conjunctivitis
  • Epidemiology
  1. Trachoma is responsible for 15% of world blindness (most common cause of preventable blindness)
  2. Highest risk of Trachoma in first 3-6 years of life
    1. Children are the primary reservoir of the disease
  3. Trachoma is a disease of poverty
    1. Affects socioeconomically disadvantaged populations and developing nations
    2. Although rare in the U.S., native americans are most often affected
  • History
  1. Trachoma was first described in 16th Century B.C. Egypt
  • Pathophysiology
  1. See Chlamydiaceae
  2. Organism: Chlamydia Trachomatis subtypes A-C
    1. Contrast with subtypes D to K (e.g. Cervicitis, Inclusion Conjunctivitis, Neonatal Pneumonia)
    2. Contrast with subtypes L1 to 3 (Lymphogranuloma venereum)
  3. Transmitted by hand to hand contact
    1. Typically transmitted between children by hand-to-hand contact of eye secretions
    2. Also transmitted when sharing contaminated clothing or towels
  4. Conjunctival scarring (Cicatricial Trachoma)
    1. Chronic follicular Conjunctivitis
    2. Chronic inflammation from recurrent infection
    3. Scarring complete by young adulthood (develops slowly over 10-15 years)
  • Findings
  1. Conjunctival injection and inflammation leading to gradual Conjunctival scarring
  2. Eyelid is is inverted inward due to scar traction
    1. Eyelashes chronically scrape the Conjunctiva and Corneal surface
    2. Chronic Corneal Abrasions lead to Bacterial Conjunctivitis and scarring
  3. Progressively Decreased Visual Acuity
    1. Blindness develops gradually over 10-15 years (typically by adulthood)
  • Labs
  1. Intracytoplasmic Inclusion Bodies
    1. Historically used to identify Chlamydia Conjunctivitis (replaced by PCR)
      1. Responsible for the Chlamydial Conjunctivitis naming (Inclusion Conjunctivitis)
      2. However, Trachoma inclusion bodies are indistinguishable from those in Chlamydia Conjunctivitis
    2. Microscopy of cell scrapings from the palpebral Conjunctiva (inner Eyelid lining)
      1. Small Basophilic (deep purple) inclusion bodies seen within Conjunctival cells
      2. An inclusion body is a Chlamydia Initial Body (Chlamydia Reticulate Body)
  • Management
  1. Azithromycin 20 mg/kg orally (up to 1 gram) for single dose (or Doxycycline 100 mg orally twice daily for 21 days) AND
  2. Topical Tetracycline or Erythromycin ointment twice daily for 28 days
  • References
  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Yanoff (1999) Ophthalmology, Mosby, p. 1.7
  3. Katusik (2003) Am J Ophthalmol 135(4): 447-51 [PubMed]
  4. Lietman (1999) Ophthalmol Clin North Am 12(1) [PubMed]
  5. Mabey (2005) Cochrane Database Syst Rev (2): CD001860 [PubMed]