Chronic conjunctivitis. Chlamydial conjunctivitis – paratrahoma and trachoma
Chronic conjunctivitis:
- conjunctivitis that lasts for more than 4 weeks is considered chronic.
- Etiology:
- Mechanical, physical and chemical factors ○ Allergies
- viruses, trachoma, paratrachoma ○ Uncorrected refraction errors ○ General causes- anemia, digestive and metabolic disorders □ Clinical characteristics:
- Subjective symptoms: itching, burning, stinging, fatigue, headache, neurasthenia ○ Objective symptoms: mild hyperemia, lack of oedema, mild discharge, often in combination with squamous blepharitis
- Course- persistant, long-lasting □ Management:
- Elimination of the cause ○ antibiotics ○ Topical astrigents ○ General hygiene activities
Chlamydial conjunctivitis – (conjunctivitis caused by chlamydia, specifically chlamydia trachomatis).
Trachoma:
- A chronic conjunctivitis caused by serotypes A-C of chlamydia trachomatis
- Third most common cause of blindness worldwide. Blindness may occur due to corneal scarring from recurrent keratitis and trichiasis
- The hallmark of the disease is subconjunctival fibrosis caused by frequent re-infections associated with the unhygienic conditions
- Infection may spread from eye to eye, or by other modes such as vector transmission through flies.
- Signs and Symptoms:
- In the absence of secondary infection, symptoms are minimal and include mild foreign body sesation in the eyes, occasional lacrimation, and scanty mucoid discharge
- In the presence of secondary infection, typical symptoms of acute mucopurulent conjunctivitis develop
- Conjunctival follicles and papillae are seen. Conjuctival scarring also develops □ Diagnosis: ○ From clinical signs (e.g. conjunctival follicles and papillae, signs of cicatrisation) ○ Laboratory diagnosis- cytology, ELISA, PCR □ Treatment:
- Oral or topical antibiotics e.g. tetracyclin or erythromyc
Paratrachoma:
- Refers to oculogenital chlamydial disease caused by serotypes D-K of chlamydia trachomatis
- It spreads from genitals to eye and mostly seen in urban population
- It manifests as either adult inclusion conjunctivitis or chlamydial ophthalmia neonatorum
- Characteristically presents in sexually active young adults as acute or subacute follicular conjunctivitis
- Signs and symptoms ○ Foreign body sensation, mild photophobia, and mucopurulent discharge ○ Conjunctival hyperaemia, superficial keratitis □ Treatment:
- Topical and oral antibiotics e.g. tetracyclin, erythromycin
Extra Info:
Grading of trachoma McCallan's classification:
- Stage I (Incipient trachoma or stage of infiltration). It is characterized by hyperaemia of palpebral conjunctiva and immature follicles.
- Stage II (Established trachoma or stage of florid infiltration). It is characterized by appearance of mature follicles, papillae and progressive corneal pannus. Stage III (Cicatrising trachoma or stage of scarring). It includes obvious scarring of palpebral conjunctiva.
- Stage IV (Healed trachoma or stage of sequelae). The disease is quite and cured but sequelae due to cicatrisation give rise to symptoms.