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  1. By chlamydia trachomatis – serotypes , A, B, Ba, C. C is commonest type in India
  2. Serotypes D-K – cause adult inclusion conjunctivitis
  3. Leading cause of preventable blindness in the world
  4. Conjunctional reaction is both follicular and papillary
  5. Chlamydia – trachomatis is epitheliotropic and produce intra – cytoplasmic inclusion bodies called H.P. bodies (Halberstaedter- Prowazeki bodies)
  6. Age 1-2 years. At 5 years prevalence of active disease declines
  1. Signs
    1. Conjunctiva Diffuse inflammation congestion, Follicles Essential lesion
      1. 5 mm in diameter
      2. Rare on Bulbar conjunctiva but pathognomic if present
      3. In mild cases scarring of follicles produces star shaped scars
      4. Horizontal streak of scar tissue is seen on upper tarsus ARLT’S LINE
      5. Herbert’s pits seen in bulbar conjunctiva
    2. Cornea Superficial punctate Keratitis in upper part of cornea
      1. Trachomatous Pannus
      2. Develops as lymphoid infiltration with vascularization of the margin of cornea
      3. Tends to spread towards centre and involve whole of cornea
      4. Level of pannus initially is b/w epithelium and Bowman’s membrane. Later Bowman’s membrane gets destroyed and superficial stroma becomes involved
        1. Progressive Pannus vessels extend to level which forms a horizontal line, beyond this line there is narrow zone of lymphoid infiltration and haze.
        2. Regressive Pannus line of lymphoid infiltration stops short of vessels  
  2. Sequeale
    • S- shaped border upper lid
    • Trichiasis, Entropion
    • Ptosis due to Tylosis and involvement of Muller’s muscle or LPS in scar tissue
    • Madarosis
    • Posterior symblepharon
    • Goblet cell destruction and lacrimal duct obstruction Xerosis
  3. Complication Only complication Corneal Ulceration. Commonest at advancing edge of Pannus, shallow, cause much lacrimation and photophobia
  4. Treatment
  • Tetracycline 1% ointment
  • Topical sulfonamides 10%, 20%, 30% drops
  • Systemic drugs in severe cases

SAFE- strategy- ( For control of trachoma) Surgery , antibiotics , facial cleanliness, environment
S- Surgery for trichiasis / entropion
A- Antibiotics for active infection
F- Facial cleanliness
E- Environmental hygiene

Table: The world Health Organization (WHO) classification of trachoma (FISTO)
Prevalence in 0-9 yr. olds <5% - Individual Rx
                                             5% - Targeted Rx of family
                                           >10% - Mass prophylaxis

Table: The world Health Organization (WHO) classification of trachoma (FISTO)



Implies active disease which needs treatment

Trachomatous inflammation, follicular: 5 or more follicles of at least 0.5 mm diameter on the upper tarsal plate should be present. Some papillae may be present in addition on but the palpebral conjunctival blood vessels are visible. This stage implies that the patient, if properly treated, should recover with no scarring or minimal scarring.



Severe disease which needs urgent treatment

Trachomatous inflammation, intense the follicles and papillae are so numerous and inflamed that more than 50% of the palpebral conjunctival blood vissels can not be seen clearly. This stage indicates a sever infection with high risk of serious complications.



Old, now inactive infection

Trachomatous scarring: tarsal conjuctival cicatrization with white fibrous bands



Needs corrective surgery

Presence of at least one trichiatic eyelash



Corneal opacities from previous trachoma cause visual loss

Presence of a corneal opacity covering part of the papillary region.

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