Eye
Conjunctiva
Trachoma (inclusion conjunctivitis)

Author: Deepali Jain, M.D. (see Authors page)

Revised: 26 April 2018, last major update November 2013

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Trachoma [title] inclusion conjunctivitis

Cite this page: Jain, D. Conjunctiva: trachoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyetrachoma.html. Accessed September 25th, 2018.
Epidemiology
Sites
  • Entire conjunctiva but most prominent on upper tarsus
Etiology
  • Caused by Chlamydia trachomatis, serovars A, B, Ba, and C of Chlamydia trachomatis
  • Serovars D-K associated with adult inclusion conjunctivitis
  • Causes scarring of corneal tissue
Clinical features
  • Active trachoma:
    • Most common in preschool children
    • Mixed follicular / papillary conjunctivitis associated with a mucopurulent discharge
    • Superior epithelial keratitis and pannus
  • Cicatricial trachoma:
    • Most common in middle age adults
    • Linear or stellate conjunctival scars (mild cases)
    • Broad confluent scars or Arlt lines in severe cases
  • Adult inclusion conjunctivitis:
    • Acute mucopurulent conjunctival infection
    • Superior limbal follicles may resolve to leave a row of shallow depressions (Herbert pits)
    • Trichiasis, distichiasis, corneal vascularization and cicatricial entropion
    • Corneal opacification
    • Dry eye
WHO grading system
  • TF:
    • 5 or more follicles on the upper conjunctiva
    • Follicles must be at least 0.5 mm in diameter and are round, white, paler than surrounding conjunctiva
  • TI:
    • Intense trachomatous inflammation
    • Tarsal conjunctiva appears red, rough and thickened, obscuring more than half of the normal, deep, tarsal vessels
    • Numerous follicles are partially covered by thickened conjunctiva
  • TS:
    • Scarring and fibrosis of tarsal conjunctiva due to severe or chronic trachoma
    • Also called cicatricial trachoma
    • Scars are visible as white lines, bands or sheets
  • TT:
    • Trichiasis defined as at least one eyelash that rubs on eyeball due to entropion of lid
  • CO:
    • Corneal opacity
    • Eyelashes have abraded and damaged cornea, causing corneal opacity and visual loss
Laboratory
Treatment
Clinical images

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WHO grading

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Presence of five or more follicles

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Thickening of the tarsal conjunctiva

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Scarring in the tarsal conjunctiva

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Evidence of recent removal of inturned eyelashes

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Corneal opacity over the pupil

Microscopic (histologic) description
  • Stage I:
    • Conjunctival inflammatory infiltrates (lymphoid follicles and diffuse infiltrates)
    • Followed by pannus formation (fibrovascular tissue in conjunctival and corneal stroma) with Chlamydia elementary bodies and larger basophilic initial bodies seen
    • Also lymphocytes, plasma cells, neutrophils
  • Stage II:
    • Florid inflammation, more follicles, epithelial thickening, severe pannus
    • Macrophages with ingested debris (Leber cells) in conjunctiva
  • Stage III:
    • Scarring
    • No follicles
    • Cicatricial entropion (inversion of upper lid)
    • Misdirected lashes (trichiasis)
  • Stage IV:
    • Arrest of disease due to entropion and trichiasis but with continuing corneal damage and infection
Microscopic (histologic) images

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Chlamydia inclusions