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https://upload.medbullets.com/topic/121871/images/trachoma.jpg
https://upload.medbullets.com/topic/121871/images/herberts_pits.jpg
Snapshot
  • An 8-year-old boy presents to the pediatric emergency department for eye pain and redness. He recently emigrated from Ethiopia to the United States. His parents report that other children in their area also experienced similar symptoms. Physical examination is notable for multiple dome-shaped, yellow-white follicles in the tarsal conjunctiva. He is prescribed oral azithromycin. 
Introduction
  • Overview
    • ocular infection caused by Chlamydia trachomatis
      • serotypes A, B, and C
  • Epidemiology
    • prevalence
      • highest in young children
    • risk factors
      • poor access to water
      • overcrowding
      • poor hygeine
    • transmission
      • ocular and nasal secretions on the fingers
      • fomites
      • eye-seeking flies
        • serves as passive vectors
  • Pathophysiology
    • conjunctival epithelium of the eye leads to an immune response 
      • repeated infections lead to tissue destruction and scarring
  • Prognosis
    • in endemic areas, repeated infections are common
    • corneal opacification may occur in untreated cases
Presentation
  • Symptoms/physical exam
    • follicular conjunctivitis (active disease) 
      • dome-shaped, yellow-white elevations of lymphoid cell collections
      • blood vessels are found around the base
      • Herbert pits 
        • there may be depressions in the upper margin of the cornea
          • this is pathognomonic for trachoma
    • cicatricial disease
      • recurrent infection leads to conjunctival inflammation, which leads to eyelid scarring
        • scarring of the eyelid can distort the lid margin, leading to entropion and trichiasis
Studies
  •  This is a clinical diagnosis
Differential
  • Viral conjunctivitis
    • differentiating factors
      • sandy, burning, or gritty sensation in the eye
      • watery or mucoserous discharge
  • Bacterial conjunctivitis
    • differentiating factors
      • purulent discharge
Treatment
  • Medical
    • oral azythromycin 
      • indication
        • treatment of choice
      • comments
        • given that trachoma is a highly contagious, it is effectively transmitted in places with poor hygiene
        • the most effective way of treating this condition is via antibiotic therapy of a mass region
    • topical tetracycline 
      • indication
        • alternative treatment when azithromycin is not available
  • Surgical
    • bilamellar tarsal rotation (BLTR) or posterior lamellar tarsal rotation (PLTR)
      • indication
        • treatment for trichiasis
Complications
  • Corneal abrasions
  • Blindness

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Questions (3)

(M2.OP.15.12) A 6-year-old immigrant from West Africa is being evaluated after recently arriving to the United States. He is observed to be rubbing and scratching at his eye. On physical exam, the eyelid is everted and the finding is shown in Figure A. This condition is most likely to cause blindness through which mechanism?

QID: 105378
FIGURES:
1

Viral infection of the cornea

4%

(1/24)

2

Bacterial infection of the cornea

21%

(5/24)

3

Fungal infection of the cornea

8%

(2/24)

4

Benign growth from conjunctiva onto the cornea

12%

(3/24)

5

Neovascularization of the cornea

50%

(12/24)

M 6 E

Select Answer to see Preferred Response

(M2.OP.15.5378) A 4-year-old boy who was recently adopted from Ghana is brought to his pediatrician's office. His mother notes he often scratches his right eye and also seems to have poor vision in that eye. On exam, the right eyelid appears similar to Figure A with eversion. Which of the following is the best treatment for this patient?

QID: 106991
FIGURES:
1

Topical tetracycline

52%

(13/25)

2

Topical vidarabine

20%

(5/25)

3

Topical prednisone

12%

(3/25)

4

Oral antihistamines

8%

(2/25)

5

Surgical removal of eyelid lesions

4%

(1/25)

M 7 E

Select Answer to see Preferred Response

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Evidence (2)
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