Eye diseases. Trachoma (most important)

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Eye diseases. Trachoma (most important)

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20. Trachoma

Trachoma is a chronic infectious eye disease. The causative agent of infection is the microorganism chlamydia, which causes damage to the conjunctiva and cornea with an outcome in scarring, destruction of the cartilage of the eyelids and complete blindness. The causative agent of trachoma in its properties and cycle of intracellular development is similar to other chlamydia.

The incubation period is seven to fourteen days. The onset of the disease is acute, but in many patients it develops gradually, and the course of the infection is chronic. Both eyes are usually affected. With the acute onset of the disease, symptoms of acute conjunctivitis are observed (redness of the skin of the eyelids, photophobia, copious mucopurulent discharge, the conjunctiva is swollen and hyperemic).

There are four stages during the trachomatous process:

1) the development of a follicular reaction, lymphoid subconjunctival infiltration, limbitis (inflammation of the limbus) and pannus of the cornea;

2) the appearance of scars replacing follicles;

3) the predominance of scarring of the conjunctiva and cornea;

4) ending scarring, covering the conjunctiva, cornea, cartilage of the eyelids.

There are four forms of the disease:

1) follicular, in which predominantly follicles are observed;

2) papillary with a predominance of papillary growths;

3) mixed, when both follicles and papillary growths are found;

4) infiltrative, characterized by predominant infiltration of the conjunctiva and cartilage of the eyelids.

The clinical picture of trachoma when infected in early childhood is similar to neonatal blenorrhea. Repeated exacerbations in these patients cause the development of corneal cicatricial changes characteristic of trachoma.

The consequences of trachoma are due to the process of scarring, which leads to the appearance of adhesions between the conjunctiva of the eyelid and the eyeball. Pronounced scarring of the conjunctiva in combination with trichiasis (improper growth of eyelashes) and inversion of the eyelids leads to a decrease in vision, and scarring and clouding of the cornea to partial or complete loss of vision.

The diagnosis of trachoma is established when at least two of the four cardinal signs of the disease are detected, such as follicles on the conjunctiva of the upper eyelid, follicles in the region of the upper limb or their consequences (fossae), typical conjunctival scars, pannus, more pronounced in the upper limbus.

Treatment. Topically apply 1% ointments or solutions of tetracycline, erythromycin, oletethrin, 10% solutions of sodium sulfapyridazine, 5% ointments or 3050% solutions of etazol 36 times a day. If necessary, after one to two weeks from the start of treatment, follicle expression is performed.

Author: Shilnikov L.V.

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