Trachoma-NBR

Trachoma:

Trachoma Trachoma is a keratoconjunctivitis caused by the bacterium Chlamydia trachomatis Trachoma inflamation may undergo spontanious resolution or may progress to conjenctival scarring which can cause inward deviation of eye lashes (Trichiasis) or of the lid margine (entropion)

Trachoma is classified as Blinding and Non-Blinding Blinding trachoma : entropion trichiasis and corneal ulcers it requires urgent control measures treatment Non Blinding : often becomes blinding trachoma :

Trachoma is classified as Blinding and Non-Blinding Blinding trachoma : entropion trichiasis and corneal ulcers it requires urgent control measures treatment Non Blinding : often becomes blinding trachoma

Trachoma:

Trachoma The leading cause of infectious blindness worldwide Trachoma is a major preventable cause of Blindness in developing countries Incidence and prevalence of trachoma has shown sig decrease because Improved sanitation water and housing conditions Endemic in 48 countries throughout the world 0.2% of visual impairment and blindness in India

Epidemiological determinants Agent factors::

Epidemiological determinants Agent factors : Agent : C.Trachomatis of immune type A,B or C the sexually transmitted C.Trachomatis (serotypes D,E,F,G,H,I,J or K) may also infect Milder cases of this are usually called “ Inclusion conjunctivitis” Reservoir : Active cases and carriers Source of infection : ocular discharges of infected persons and fomites Communicability : it is a disease of low infectivity

Epidemiological determinants Host factors:

Epidemiological determinants Host factors Age : children from the age group 2- 5 yrs are the most commonly infected Sex : in younger age group equal in both sexes In older age group children girls are effected more Predisposing factors : direct sunlight , dust,smoke and irritants such as kajal or surma

Epidemiological determinants Environment:

Epidemiological determinants Environment Season : Associated with vastly increased number of eye seeking flies In India during April-May and again during July-Sept The higher temperature and rainfall favor increase in fly population Quality of life : trachoma is associated with poor personal hygiene squalor illiteracy and poor housing Customs : apply of Kajal or Surma to the eyes

Modes of Transmission :

Modes of Transmission Eye to eye transmission can occur by direct or indirect contact with ocular discharges of infected persons or fomites Ex: infected fingers ,towels , kajal or surma eye seeking flies Incubation period : 5 to 12 days

Natural History of Trachoma :

Natural History of Trachoma Active disease with inflammatory follicles 2. Scarring 3. Trachomatous blindness .

Active Disease Is Characterised by Inflammatory Follicles :

Active Disease Is Characterised by Inflammatory Follicles

Trachomatous Scarring (TS):

Trachomatous Scarring (TS) Trachomatous scarring (TS) is recognised by the presence of easily visible white bands on the underside of the upper eyelid, and is more prevalent with increasing age

TS Develops in Response to the Inflammation of Active Disease :

TS Develops in Response to the Inflammation of Active Disease TS: fine transverse lines crossing over the vessels (B) Severe scarring

Trachomatous trichiasis (TT), :

Trachomatous trichiasis (TT), Severe scarring can result in contraction of the tarsal conjunctiva; this causes the lid margin to roll inwards and results in lashes contacting the globe. Called trachomatous trichiasis (TT)

Corneal Opacity (CO):

Corneal Opacity (CO) Constant abrasions of the lashes on the cornea are painful and rapidly produce scarring and corneal opacities (CO) Once the cornea has become opaque, visual loss is essentially irreversible.

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TT scarring and contraction has pulled the lid margin in, and eyelashes now touch the globe (B) CO results from the constant abrasion of lashes on the cornea

Control of Trachoma:

Control of Trachoma 1.Assesment of the problem 2.Chemotheraphy Mass treatment Selective treatment Surgical correction Surveillance Health education Evaluation

1.Assesment of the problem:

1.Assesment of the problem The primary objective of a programme for the control of trachoma is the prevention of blindness Blinding trachoma as indicated by the presence of Corneal blindness Trachomatous trichiasis and Entropion Moderate and severe trachoma

2.Chemotheraphy Mass treatment:

2.Chemotheraphy Mass treatment It is used to reduce severity, lower the incidence and in the long run decrease the prevalence The antibiotic of choice is 1% ophtholmic ointment or oily suspension of Tetracyclines . Erytromycin and Rifampicine have also been used in the treatment Mass Treatment : may be given to the entire community is also known as Blanket treatment A prevalence of 5% severe and moderate trachoma in children under 10yrs is indication for mass treatment Rx consists of tetracycline- BID for five days each month or OD for 10days each month for 6 consecutive months Selective treatment : in communities with low to medium prevalence treatment should be applied to individuals by case finding

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Surgery to correct advanced stages of the disease

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Antibiotic distribution of Pfizer-donated Zithromax® to treat active infection

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Face washing to reduce disease transmission

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Environmental change to increase access to clean water and improved sanitation

Surveillance and Health education:

Surveillance and Health education Surveillance : once control has been achieved provision must be made to maintain surveillance Health education : Mothers of young children should be target for health education Measures of personal and community hygiene. Permanent change in the behavior pattern and environmental factors. Improve of living conditions and quality of life of the people

Evaluation :

Evaluation

Thank You!:

Thank You!