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[[File:Gray894.png|thumb|The tarsi and their ligaments. Right eye; anterior view.]]
[[File:Gray894.png|thumb|The tarsi and their ligaments. Right eye; anterior view.]]
[[File:eyelid glands.png|thumb]]
[[File:eyelid glands.png|thumb]]
*'''Most common cause of infectious blindness worldwide'''
*Most common cause of infectious blindness worldwide
*Caused by [[Chlamydia trachomatis]]
*Caused by [[Chlamydia trachomatis]]
**Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals)
**Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals)
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==Clinical Features==
==Clinical Features==
[[File:trachoma.jpg|thumbnail|[http://www.flickr.com/photos/communityeyehealth/5686867974/in/photolist-9yvAnR-9yvAf2-9yyAQw-9yyBq3-9yyB9Y-9EwFHQ-dW9VqU-dW4jzi-dW9Vqf-9yyBE1-9yvA22-9EtLZc-9wnCPz-fkvMSo-9yyAVm-dWa7P1-dWa7HU-dWa7mQ-9wqCPE-9wS7eH-dW4vt4-dWa7C7-dW4vNv-dW9VpW-dW4vnv-dWa7SL-dWa7Gw-dW4w8T-dWa7Vw-9yyAMU-dWa7e3-dWa7sQ-fofWkV-dW4vAD-dWa7zd-dW4vAH-9i9MxD-fkoX9y-9Ab3zW-cQSPYL-cXe39U-dhUoe1-9yvA88-9wV76Q-9yvAqM-pWqs-9hocNj-aBgF8w-9oSHXb-dWuo2J Trachoma Stages]]]
[[File:Corneal scarring trachoma.jpg|thumb|Corneal Scarring - End Stage Trachoma]]
===Acute===
===Acute===
*[[Conjunctivitis]]-like symptoms
*[[Conjunctivitis]]-like symptoms
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**Caused by structural changes to the inner eyelid
**Caused by structural changes to the inner eyelid
***Scarring of the inner eyelid that leads to buckling of the lid
***Scarring of the inner eyelid that leads to buckling of the lid
****This causes the eyelashes to turn inwards '''(Trichiasis)''' and rub on the cornea causing repetitive trauma that leads to opacities and scarring of the cornea  
****This causes the eyelashes to turn inwards (Trichiasis) and rub on the cornea causing repetitive trauma that leads to opacities and scarring of the cornea  
*Major complications include [[corneal ulcers]]
*Major complications include [[corneal ulcers]]


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==Evaluation==
==Evaluation==
*Clinical diagnosis
*Clinical diagnosis<ref>Solomon AW, et al. Trachoma. Nat Rev Dis Primers. 2022;8(1):32. PMID 35618795</ref>
====WHO classification====
====WHO classification====
*Simplified grading system composed of 5 clinical signs of infection
*Simplified grading system composed of 5 clinical signs of infection
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==Management==
==Management==
*'''S.A.F.E.''' strategy proposed by WHO
*S.A.F.E. strategy proposed by WHO
**'''S''' - Surgery
**S - Surgery
***Bilamellar tarsal rotation procedure recommended by WHO
***Bilamellar tarsal rotation procedure recommended by WHO
**'''A''' - Antibiotics
**A - Antibiotics
***Tetracycline 1% eye ointment
***Tetracycline 1% eye ointment
****'''Adherence issues''' secondary to difficulty in use and uncomfortable to apply
****Adherence issues secondary to difficulty in use and uncomfortable to apply
***[[Azithromycin]] (20mg/kg) single dose
***[[Azithromycin]] (20mg/kg) single dose
****Relatively expensive in resource poor settings
****Relatively expensive in resource poor settings
**'''F''' - Facial cleanliness
**F - Facial cleanliness
***Helps decrease disease transmission
***Helps decrease disease transmission
**'''E''' - Environmental management
**E - Environmental management
***WHO emphasizes access to latrine and clean water
***WHO emphasizes access to latrine and clean water


Revisión actual - 10:16 22 mar 2026

Background

Anterior view of the right eye, with lacramal duct shown medial.
The tarsi and their ligaments. Right eye; anterior view.
Eyelid glands.png
  • Most common cause of infectious blindness worldwide
  • Caused by Chlamydia trachomatis
    • Spread by direct contact, fomites (towels, clothes, bed covers), and flies (those that have landed on or near the mouth or eyes of other infected individuals)
  • More than 6 million blind secondary to trachoma and more than 150 million in need of treatment
  • Typically affects most marginalized populations in the world

Clinical Features

Trachoma Stages
Corneal Scarring - End Stage Trachoma

Acute

  • Conjunctivitis-like symptoms
    • Conjunctival follicles (white lumps) on the inner upper eyelid
    • Non-specific inflammation and thickening of the conjunctiva

Chronic

  • Known as the "quiet disease" because of its slow chronic course
  • Blindness after repeated infections
    • Caused by structural changes to the inner eyelid
      • Scarring of the inner eyelid that leads to buckling of the lid
        • This causes the eyelashes to turn inwards (Trichiasis) and rub on the cornea causing repetitive trauma that leads to opacities and scarring of the cornea
  • Major complications include corneal ulcers

Differential Diagnosis

Evaluation

  • Clinical diagnosis[1]

WHO classification

  • Simplified grading system composed of 5 clinical signs of infection
    • Follicular trachomatous inflammation (TF)
      • ≥5 follicles >0.5mm on the superior tarsal conjunctiva
    • Intense trachomatous inflammation (TI)
      • Hypertrophy of the papilla and inflammatory thickening of the superior tarsal conjunctiva (must obscure more than half of the deep vessels)
    • Trachomatous scarring (TS)
      • Scarring in the superior tarsal conjunctiva
    • Trachomatous trichiasis (TT)
      • One or more ingrown eyelash in contact with the globe or evidence of eyelash loss (epilation)
    • Corneal opacity
      • Must blur part of the pupil margin

Management

  • S.A.F.E. strategy proposed by WHO
    • S - Surgery
      • Bilamellar tarsal rotation procedure recommended by WHO
    • A - Antibiotics
      • Tetracycline 1% eye ointment
        • Adherence issues secondary to difficulty in use and uncomfortable to apply
      • Azithromycin (20mg/kg) single dose
        • Relatively expensive in resource poor settings
    • F - Facial cleanliness
      • Helps decrease disease transmission
    • E - Environmental management
      • WHO emphasizes access to latrine and clean water

Disposition

See Also

References

  1. ↑ Solomon AW, et al. Trachoma. Nat Rev Dis Primers. 2022;8(1):32. PMID 35618795
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