D i.e. Ectropion of upper eyelid Sequelae of trachoina is entropion (not ectropion)Q, corneal opacity and Xerosis (dryness)(2) Trachoma/ Egyptian Opthalmia Epidemiology Clinical Features Sequelae & Complication Diagnosis * Etiological agent * Incubation pd. is 1-3 weeks * Sequelae are changes * Clinically, at least two of is chlamydia trachomatis * Sequelae occurs at least after 20 years, so peak incidence of blinding is in 4th- occurring as a pa of the natural history of these sign should be present to establish the diagnosis serotype A, B, Ba, 5th decade disease i) Presence of follicles more CQ (a Bedsonian - * Symptoms- - Lids: tylosis in the upper than lower PLT organism) - In absence of secondary infection (thickening of lid palpebral conjuctiva * 1/5th of world symptoms are minimal & include mild margin), Trichiasis ii) Epithelial keratitis in the population is foreign body sensation (inward misdirection early stages most marked in affected - In presence of 2deg infection typical of cilia), entropionQ upper pa of cornea * Predisposing symptoms of acute mucopurulent (inturning of the lid iii) Pannus in upper pa of factors conjunctivitis develop eg. lacrimation, margin), ptosis cornea - Infancy & photophobia discharge etc (drooping of upper iv) Limbal follicles or their childhood * SignsQ - eyelid), madarosis sequelae as Herbe pitsQ - Females I. Conjuctival signs (absence of cilia), v) Stellate scarring in - Dry & dusty - Congestion ankyloblepharon conjuctiva with linear weather - Concretions (adhesion between conjuctival scarring of - Low socio- - Papillary hyperplasiaQ margins of the upper upper tarsus. (Ant's line)Q economic status (Large size, typical cobble stone and lower eyelids. * Laboratory diagnosis - Unhygienic living arrangement and acidic pH of tears - Conjuctival: i) Culture of c. trachomatis in conditionsQ differentiate it from spring catarrh.) concretions, irradiated Mc Coy cells * Source of infection - Conjuctival folliclesQ : presence of pseudocyst, xerosis (expensive) is discharge, so superimposed leber cellsQ necrosis & size of >5 mm differentiate trachoma follicles from (dryness)Q, symblepharon ii) Micro immunofluorescence (micro-IF) testis bacterial infections help in others. - Conjuctival scarring: linear scar present - Corneal: opacity Q, xerosis, ectasia recommended for routine diagnostic use. transmission by increasing in sulcus subtarsalis is called, Arlt's linect (anterior staphyloma), total iii) Mc Coy cell culture, monoclonal antibody direct jcon val ucti secretion * Mode of infection II. II Corneal C Signs Sig - Superficial keratitis - Herbe folliclesQ, which form pitted corneal pannus (1/ t blindness) - Lacrinal: chronic dacryoadenitis, tests and IgA-IPA light microscopy tests form the best combination of diagnostic tools - Vector transmission by flies (m.imp.l scars after healing, known as Herbe pitsQ - Pannus i.e. infiltration of cornea chronic dacryocystitis - Glucoma iv) Cytology - Giemsa stained conjuctival smears showing - Material transfer associated with vascularization ** The only predominantly polymorpho eg. towel, handkerchief etc. between epithelium and Bowman's , membrane complication of trachoma is corneal -nuclear reaction with presence of plasma cells and - Direct spread by In progressive pannus, infiltration is ulcerQ which may Leber cells air or water ahead of vascularization In regressive pannus (pannus siccus) occur due to rubbing of concretions or - Detection of inclusion body vessels are ahead of infiltration - Corneal ulcer and opacity may develop at the advancing edge of pannus trichiasis by immunofluor escent staining v) Culture of C. trachomatis on yolk sac * SAFE strategy for trachomaQ is - Surgery for trichiasis, Antibiotics, Facial cleanliness & Environmental improvement. Treatment * Oral tetracycline, doxycycline, azithromycin, clarithromycin, erythromycin, rifampicin & sulfonamides * Oral tetracycline cannot be given to childrenyears, pregnantwomen or nursing mothers. * Sulfonamides have high risk of stevens Johnson syndrome and erythema multiforme. * Topical treatment with tetracycline or erythromycin or sulfacetamide (less preffered) is cheaper more effective and has no risk of systemic side effects.