Trachoma is a specific infectious keratoconjunctivitis caused by a virus from the psittacosis group. The disease occurs as a result of the transfer of the infectious isolate from the diseased conjunctiva to the healthy ones or through contaminated objects. The incubation period is 5-14 days.
The disease is usually bilateral, begins imperceptibly for the patient and only rarely, is acute, proceeds chronically, is characterized by conjunctivitis with the formation of follicles (grains) and lesions of the cornea in the form of superficial vascular inflammation - pannus (see). The disintegration of the follicles leads to scarring.
Fig. 1. Trachoma of the 1st stage. Fig. 2. Trachoma III stage with a twist and trichiasis of the lower eyelid. Fig. 3. Pannus with "eyes" Bonnet in the limbal region. Fig. 4. Intracellular inclusions Provacek-Halberstedtera with trachoma.
In the clinical course of trachoma, 4 stages are distinguished. Stage I - the growth of inflammatory phenomena, diffuse infiltration, edema of the conjunctiva with the development of follicles in it, which have the appearance of turbid gray grains located randomly and deeply in the conjunctiva of the transitional folds; there are initial signs of damage to the cornea in the form of a pannus (Figure 1). Stage II - against the background of increased infiltration and development of follicles, the disintegration of follicles begins and scars appear. The defeat of the cornea is more pronounced. Stage III - the processes of scarring predominate in the presence of follicles and infiltration (Figure 2). Stage IV (inactive) - diffuse scarring of the affected mucous membrane in the absence of any inflammatory phenomena in the conjunctiva and the cornea.
Specific lesions of the cornea in trachoma - pannus - starts from the upper limb, then infiltration and newly formed vessels capture the surface layer of the cornea.
Diagnosis. For early recognition of the initial trachoma, erased its forms and relapses of the disease, it is necessary to use optical diagnostic tools - a binocular magnifier for mass examinations and a slit lamp to investigate difficult cases for diagnosis (see Biomicroscopy). Characteristically, the presence of infiltration of the conjunctiva, involvement in the process of cartilage (trachomatous pseudoptosis), the change of the cornea (pannus).
Laboratory diagnostics includes 3 types of research: scraping with conjunctiva for detection of Procatsek-Halberstedter bodies, cytological picture of follicle contents, virus isolation. The epidemiological analysis , examination of the outbreak is of subsidiary importance.
The prognosis of trachoma is now favorable with timely and correct treatment. In severe form and long trachoma, intense corneal opacities can occur with reduced vision and gross common scars in the conjunctiva. Scarring can lead to curvature of the cartilage, eyelid twisting (see) and incorrect location of eyelashes (trichiasis). In this case, the lashes rub the cornea, which leads to damage to its surface and promotes the development of corneal ulcers.
The group of persistent trachoma includes cases that can not be treated by standard methods. Various factors can underlie the persistent course of trachoma: general diseases, a decrease in the resistance of the patient's body, allergic reactions, concomitant diseases of the eyelids, conjunctiva and lacrimal canals, irregular and incorrect treatment.
Trachoma, previously quite common in the territory of the USSR, is now liquidated as a mass disease. Typical clinical forms are rare.The
Treatment . Patients with active trachoma (I-III stages, relapses of the disease) are subject to inpatient treatment. Treatment is 1% ointment of tetracycline , erythromycin, or oletetrin 4-6 times a day. After 1-2 weeks from the beginning of treatment, a doctor or a specially trained middle-level medical worker extrudes follicles with special tweezers after anesthetizing the mucous membrane by instilling a 0.5% solution of dicaine or by administering a 1% solution of novocaine to the conjunctiva. The eyelids turn out and squeeze the conjunctiva with tweezers. After expression, ointment of an antibiotic is laid. Out-patient treatment is possible only in mild cases of trachoma; ointments of antibiotics are used 2-3 times a day, 1% ditetracycline ointment - once a day or every other day, instill 1% tetracycline hydrochloride solution or 10% solution of sulfapiridazine sodium on a polymer basis 1-2 times a day.
After clinical cure, patients remain on dispensary registration and undergo medical examination 4 times a year.
Prevention of trachoma recurrence, early detection and treatment is especially important in the control of trachoma, since trachoma recurrence is the main number among newly registered active cases of trachoma, and those unrecognized in time can be a source of infection. The best prevention of relapses of trachoma is the timely treatment of bacterial and viral conjunctivitis.
An important preventive measure is sanitary and educational propaganda aimed at maintaining personal hygiene. A sick or ill trachoma should have a separate towel, pillow, etc.