July 16, 2012 A form of conjunctivitis caused by Trachoma virus, which belongs to a group of atypical PLT-viruses, which take place between real viruses and bacteria, and with their properties they are similar to rickettsiae. The occurrence of trachoma is specific for areas along the estuaries of rivers with quiet flow, swamp areas, coasts of shallow warm seas, in families with low living standards and in poor hygienic conditions. The virus is transmitted with hands from patient’s eye, towel etc, lice or flies can also transmit the disease.
The disease develops in 4 stages:
1) Pre-follicular stage – early lymphoid infiltration. The clinical picture is a picture of acute inflammation of the conjunctiva, but on the conjunctiva of the upper tarsus appears dark red papillary hypertrophy with somewhat limited yellow-reddish speckles.
2) Focullar stage – granulous. Trachoma speckles are developed in the fornix, they are not sharply limited and they are dark red, and the conjunctiva between them is thickened and infiltrated so that the conjunctiva of the upper eyelid looks like a raspberry. Secretion is mucopurulent and contains insertable corpuscles and super-infective bacteria.
3) Florid or pre-cicatricial stage – at the center of trachoma speckles appears necrosis, speckles burst, and the content empties into conjunctiva bag. On the conjunctiva are visible reddish gelatinous speckles which are being connected, also, swells of papillary hypertrophy appear, as do grey-white net-like scars. The eyelid is red, thickened and lowered. The patient has a sleepy look (ptosis trahomatosa). On the cornea appears trachoma pannus; that is the infiltration of cornea between the external epithelium and Bowman membrane with lymphocytes, fibroblasts, epitheloid cells and plasma cells. Panus is limited to the upper part of the cornea, from where it spreads toward the center; blood vessels grow into cornea which leads to its blurriness; at the edge of pannus appear ulcerations from which ulcus serpens can develop.
4) Cicatricial stage – result of trachoma. The clinical picture shows that hypertrophic conjunctiva disappears and leaves a scar. After the recovery the conjunctiva is bluish-white with scars. Conjunctiva of fornix contracts, which leads to cicatricial entropy and trichiasis. The worst complication is trachomatis keratokserosis when it comes to metaplasia of epithelium of conjunctiva and cornea which keratinizes.
Symptoms:
Trachoma speckles, pannus, scars.
Treatment:
Extruding trachoma speckles, antibiotics (sulfonamids, aureomicin), possible surgery because of uneven position of eyelids.