Trachoma in children: causes, symptoms, diagnosis, treatment

Trachoma is an infectious eye disease caused by chlamydia. The conjunctiva and cornea are affected chronically with scarring of the conjunctiva and eyelid cartilage.

ICD-10 code

A71 Trachoma.

Epidemiology

Trachoma, a widespread disease in the recent past, is currently found in isolated cases in the CIS countries, mainly in the southern regions. Up to 90% of newly diagnosed patients are people with recurrent trachoma.

The source of infection is patients with active forms, especially with latent clinical manifestations, as well as carriers of the pathogen. Low living standards, overcrowding, lack of sanitary skills, etc. play a major role in the spread of trachoma. Transmission of the infection is carried out almost exclusively through direct or indirect contact - through hands, handkerchiefs, towels, etc.

Classification of trachoma

Depending on the clinical manifestations, there are follicular, papillary (with a predominance of papillary growths), infiltrative (infiltration of the conjunctiva and cartilage of the eyelids) and mixed (follicles and papillary growths are detected) forms of the disease.

In typical cases, the pathological process goes through four stages:

• Stage I - initial, immature follicles appear, the so-called trachomatous grains with superficial infiltration of the cornea;
• Stage II - active trachoma, further development of follicles (mature follicles) with papillary hyperplasia mainly in the area of transitional folds and cartilage, formation of pannus and infiltrates in the cornea;
• Stage III - scarring of necrotic follicles (scarring trachoma);
• Stage IV - cicatricial trachoma with complete replacement of follicles and infiltrates with cicatricial tissue. In essence, this is a cure for trachoma with anatomical defects.

Pathogenesis of trachoma

Initially, the pathogen affects the conjunctiva and corneal epithelial cells. Then the process spreads to deeper tissues, involving the cartilage of the eyelids and developing cicatricial changes.

Symptoms of Trachoma

The incubation period of trachoma is 1-2 weeks. The disease may begin both acutely and gradually. With an acute onset of the disease, a picture of rapidly progressing conjunctivitis occurs: swelling and hyperemia of the eyelids, abundant mucopurulent discharge from the eyes, burning and photophobia. With a gradual onset, the first signs of the disease may be minor discharge from the eyes, a feeling of awkwardness in the eyes, lacrimation. Inflammatory changes gradually increase. At the height of clinical manifestations, patients complain of pain in the eyes; the conjunctiva is edematous, hyperemic.

Diagnosis of trachoma

Clinical diagnosis of trachoma is based on the detection of follicular conjunctivitis on the upper eyelid, vascular growth into the cornea in the upper limbus, cicatricial changes, etc. For laboratory confirmation of the diagnosis, the same methods are used as for other forms of chlamydial infection.

Differential diagnostics

Trachoma is differentiated from paratrachoma, ophthalmia with inclusions, conjunctival pemphigus, gonococcal conjunctivitis, and molluscum contagiosum.

Treatment of trachoma

Macrolide antibiotics and sulfonamide drugs are used to treat trachoma.

Prevention of trachoma

Specific prevention has not been developed. Of primary importance are early detection and treatment of patients, as well as extensive health education work among the population and strict control over compliance with hygiene requirements in trachoma foci.