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TrachomaPACES 2
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What is Trachoma?
Infection of eyes from Chlamydia trachomatis
serotypes A, B, Ba and C
Endemic in certain developing countries
Australia is the only developed country to
have endemic trachoma
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How is Trachoma spread?
Contact with mucopurulent discharge from
infected eyes
Can be eye-to-eye contact, or through infected
environments.
Can also be spread by flies that have
contacted infected eyes.
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Diagnosis of Trachoma requires at
least 2 of the following:
Lymphoid follicles on upper tarsal conjunctiva
Vascular pannus formation
Characteristic conjunctival scarring
Limbal follicles or their sequelae, Herbert-s
pits
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Grading of Trachoma
A: Normal eye
B: Trachomatous inflammation follicular
C: Trachomatous inflammation intense
D: Trachomatous scarring
E: Trachomatous trichiasis F: Corneal opacity
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A: Normal Everted Tarsal Plate
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B: Trachomatous Inflammation -
Follicular
5 follicles on
upper tarsal
conjunctiva 0.5mm diameter
Paler than
surroundingconjunctiva
white/ grey/ yellow
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C: Trachomatous inflammation -
Intense
Red, rough thickened tarsal
conjunctiva
Thickening of tarsal
conjunctiva
Obscures > of deep tarsal
vessels Partially/totally obscures the
numerous follicles
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D: Trachomatous scarring
Glistening/ fibrous white
lines/ bands/ sheets on
upper tarsal conjunctiva
If diffuse, may obscure tarsal
vessels
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E: Trachomatous trichiasis
1 eyelash rubs
on eyeball
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F: Corneal Opacity
Visible corneal opacity
over pupil
Pupil margins are
blurred as viewed
through the opacity
VA affected less than6/18
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Investigations
Giemsa-stained conjunctival smears:
intracytoplasmic chlamydia inclusions
Chlamydia Nuclear Acid Amplification Tests
(NAATs)
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How to treat Trachoma?
Medical Antibiotics azithromycin 20mg/kg
up to 1000mg, single oral dose.
If pt
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SAFE strategy to eliminate blinding
Trachoma
Surgery
Antibiotics
Facial cleansing reduces exposure to flies for
those at risk
Environmental health aims to eliminate
areas for flies
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Bilaminar tarsal rotation
Indications: 1 eyelash turns in
and scratches
cornea when ptlooks straightahead
Evidence of cornealdamage bytrichiasis
Severe discomfortfrom trichiasis
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Bilaminar tarsal rotation
Fix lid
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Bilaminar tarsal rotation
Fix lid
Incise skin & muscle
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Bilaminar tarsal rotation
Fix lid
Incise skin & muscle
Evert lid, and incise
conjunctiva and
tarsal plate (same
line as above)
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Bilaminar tarsal rotation
Fix lid
Incise skin & muscle
Evert lid, and inciseconjunctiva andtarsal plate (sameline as above)
Unite the incisionsuse scissors.
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Bilaminar tarsal rotation
Fix lid
Incise skin & muscle
Evert lid, and inciseconjunctiva and tarsalplate (same line asabove)
Unite the incisions use
scissors. Reattach distal fragment
in outwardly rotatedposition
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Bilaminar tarsal rotation
Before After