Etiology, Pathophysiology, Ocular Manifestations, Differential Diagnosis, Complications, and Management of Trachoma

Introduction

Trachoma is a chronic infectious disease caused by Chlamydia trachomatis, leading to blindness in severe cases. Understanding its etiology, pathophysiology, and ocular manifestations is essential for proper diagnosis and treatment.

Etiology

Trachoma is primarily caused by repeated infections of Chlamydia trachomatis transmitted through direct contact, fomites, or flies acting as mechanical vectors.

Pathophysiology

The infection begins as follicular conjunctivitis, progressing to chronic inflammation, scarring, trichiasis, and eventual corneal opacification leading to blindness.

Ocular Manifestations

• Follicular conjunctivitis in early stages
• Conjunctival scarring leading to trichiasis
• Corneal opacity due to persistent irritation
• Pannus formation over the cornea

Differential Diagnosis

Conditions mimicking trachoma include conjunctivitis of various etiologies (viral, bacterial, allergic), ocular pemphigoid, and dry eye syndrome.

Complications

• Persistent corneal irritation
• Vision loss due to scarring
• Secondary bacterial infections worsening the prognosis

Management

Treatment follows the WHO SAFE strategy:

• S: Surgery for trichiasis
• A: Antibiotics like azithromycin
• F: Facial cleanliness to reduce transmission
• E: Environmental improvement to limit exposure

Conclusion

Trachoma remains a global concern, requiring a multidisciplinary approach to reduce transmission and prevent blindness.