Trachoma – the chronic chlamydial infection affecting a conjunctiva and a cornea of eyes. Trachoma is shown by symptoms of conjunctivitis, a keratit, formation of trakhomatozny grains (follicles) on a conjunctiva. In the outcome trachoma can lead to scarring mucous, to destruction of a cartilage a century and a total blindness. In diagnosis of trachoma the biomicroscopy, a cytologic research of buccal swabs about conjunctivas, the IFA, RIF, PTsR methods is used. In treatment of trachoma instillations and local imposing of antibacterial ointments, vitamin therapy, an immunotherapy, an expression and a diatermokoagulyation of follicles, an epilation of eyelashes are used. Complications of trachoma are eliminated with a surgical way.
The causative agent of trachoma is Chlamydia trachomatis, an intracellular parasite who breeds in cytoplasm of epitelialny cages of a conjunctiva and cornea. The causative agent of trachoma was opened by Provachek and Halbershtedter in 1907. Now trachoma in large quantities occurs among the population of Southeast Asia, South America and Africa; in the territory of Russia only sporadic cases are registered. The active course of trachoma is mainly characteristic of children of 4-10 years; rough consequences of an infection in the form of a trikhiaz, a zavorota a century, a blindness develop at persons 50 years are more senior. In ophthalmology trachoma 3 times more often is diagnosed for female persons.
Trachoma is an antroponozny infection with the epidemic nature of distribution. Transfer of the activator happens in the contact way through polluted by allocations (tears, slime, pus) of a hand, objects of use and hygiene, clothes. In trachoma epidemiology the leading role belongs to unsatisfactory living conditions and low level of sanitary culture of the population.
Are sources of spread of trachoma both patients with active forms of an infection, and carriers of the activator, the person with the atypical and erased course of a disease. The possibility of mechanical transfer of activators is not excluded by insects (flies). The high general susceptibility to trachoma in epidochaga is characteristic. Immunity after the postponed infection is not developed, therefore, perhaps repeated infection with trachoma.
The most expressed morphological transformation at trachoma is undergone by a conjunctiva and a cornea. Initial changes are characterized by diffusion infiltration of a conjunctiva neutrophils and gistiotsita, then (from 10-12 days) - lymphocytic and plazmokletochny infiltration. On mucous a century follicles (trakhomatozny grains) presented by a focal congestion of lymphocytes are formed. Further in the field of follicles there are dystrophic changes, a sclerosis and conjunctival fabrics. Perhaps rassasyvany follicles without formation of hems. In some cases around follicles the capsule which "immures" cellular infiltrates is formed, promoting preservation of the causative agent of trachoma for many years.
In a cornea at trachoma diffusion inflammatory process with distribution of infiltration and neogenic vessels to the top part of a limb and formation of a trakhomatozny pannus develops. At the heavy course of trachoma follicles are formed in Strom of a cornea; infiltration and scarring extend to plaintive bodies and deep layers of a cartilage a century and meybomiyeva of gland.
Classification of trachoma
According to pathogenetic changes in development of trachoma allocate 4 stages.
In the first (initial) stage of trakhomatozny process the inflammatory phenomena in a conjunctiva are noted, trakhomatozny grains in an upper eyelid and transitional folds appear, hypostasis and a vaskulyarization of the top part of a limb, superficial subepitelialny infiltration of a cornea develops.
The second (active) stage of trachoma proceeds with maturing of follicles, their papillary giperplaziya, formation of a pannus and infiltrates of a cornea, a necrosis of separate follicles and their scarring.
In the third (cicatrizing) stage of trachoma processes of scarring of a conjunctiva and transitional folds a century, corneas prevail at preservation of the phenomena of an inflammation.
The fourth (cicatricial) stage of trachoma is characterized by signs of clinical treatment – in the field of a conjunctiva, a cornea and cartilages the century occurs full replacement of follicles and infiltrates with cicatricial fabric. In the fourth stage of trachoma on the basis of criterion of easing of sight allocate 4 groups: 0 - without decrease in sight; I - decrease in sight to 0,8; II - decrease in sight to 0,4; III - decrease in sight is lower than 0,4.
Depending on the prevailing pathological elements I distinguish the following forms of trachoma:
- follicular – with primary formation of follicles;
- papillary – with formation of sosochkovy growths;
- mixed – with a combination of follicles and sosochkovy growths;
- infiltrative – with primary infiltration of the interested structures of an eye.
The incubatory period at trachoma takes 7-14 days. Disease demonstration more often sharp, course of trachoma long, chronic. Both eyes are usually involved in trakhomatozny process. Emergence in the opinion of burning sensation and feelings of a foreign matter is noted. At the sharp beginning of trachoma conjunctivitis symptoms – hyperaemia and puffiness mucous a century, plentiful separated mucopurulent character, a photophobia are brightly expressed. On mucous a century follicular or papillary growths come to light.
In a quarter of cases perhaps erased course of trachoma which can be regarded as chronic conjunctivitis. The course of trachoma at children of early children's age reminds . Frequent exacerbations of trachoma at children lead to cicatricial changes of a cornea which come to light at eye biomicroscopy.
Weight of course of trachoma is connected with extent of infiltration of a conjunctiva and involvement in trakhomatozny process of a cornea. As the burdening moments in development of trachoma serve stratification of bacterial or viral conjunctivitis, a purulent keratit, dakrioadenit, dakriotsistit, kanalikulit, decrease in immune responsiveness, existence of other diseases (tuberculosis, a skrofulez, a helminthic invasion, malaria, etc.). In case of accession of a secondary infection trachoma quite often is complicated by a cornea ulcer, iridotsiklity, a hypopeony, a perforation, endo-and panoftalmity.
As outcome of a recidivous course of trachoma serves the scarring of a conjunctiva in the field of transitional folds which is characterized by formation of unions between an internal surface of a century and an eyeball. It leads to shortening of the conjunctival arches or their total disappearance (). Cicatricial changes of a cartilage at trachoma cause development of a zavorot a century, a trikhiaz, omissions of an upper eyelid. Cicatricial processes in plaintive gland are followed by reduction of a slezootdeleniye and drying of a conjunctival and corneal surface (a syndrome of a dry eye). In total all designated changes cause decrease in sight, and turbidity and scarring of a cornea can become the reason of partial or full loss of sight.
Diagnosis of trachoma
Preliminary recognition of trachoma is based on kliniko-diagnostic signs. At external examination of eyes the ophthalmologist is guided by existence of deep infiltration of fabrics, follicles, changes in a limb and a cornea, hems.
Confirmation of the diagnosis of trachoma is carried out by a cytologic research of scrape from a conjunctiva: at identification in epitelialny cages of specific cytoplasmatic inclusions - Provacheka-Halbershtedter's little bodies the diagnosis does not represent doubts. From methods of laboratory diagnosis of trachoma IFA (identification of specific antibodies to hlamidiya in blood serum), the REEF (detection of anti-genes of hlamidiya in epitelialny cages), a scrape PTsR-research, a cultural method are used (a bacteriological research of dab from a conjunctiva).
For more detailed research of defeats of a conjunctiva, a cornea and plaintive ways the eye biomicroscopy, flyuorestseinovy instillyatsionny test, color plaintive and nasal test is carried out. Further for assessment of weight of complications of trachoma visual acuity check, a diafanoskopiya of an eye and its appendages, etc. researches can be required.
Treatment of trachoma
Topichesky therapy of trachoma is carried out by means of instillations of solutions and a mortgaging to a conjunctival bag of antibiotics and sulfanylamides (a drop and ointment with tetratsikliny, erythromycin, oletetriny, doxycycline, sulfapiridaziny sodium, etc.). At severe forms of trachoma antibiotics of a tetracycline row are appointed inside. Include rates of interferon and inductors of interferon, immunomodulators in complex therapy of trachoma.
The expression (expression) of follicles by means of special tweezers under local anesthesia belongs to mechanical methods of treatment of trachoma. The expression of follicles is a small surgical manipulation which due to be carried out taking into account requirements of an asepsis and antiseptics. It allows to reduce terms of treatment of trachoma and to achieve more bystry and gentle scarring of mucous. Repeated expression of follicles if necessary spend each 12-15 days under cover of medicamentous therapy. In some cases resort to a repeated diatermokoagulyation of multiple infiltrates.
At consequences of trachoma resort to surgical treatment which depends on character of complications. Elimination of a trikhiaz is carried out by a careful mechanical epilation of eyelashes, by means of electrolysis or cryosurgery. At a combination of a trikhiaz to deformation the century is made plastic correction of a zavorot a century. At a persistent trikhiaz to the region a century replace a rag of a mucous membrane of a lip which allows to distance incorrectly growing eyelashes from an eyeball.
At a kseroftalmiya for moistening of a surface of an eye implant into the arch of a conjunctival cavity parotid a channel of salivary gland. Chronic purulent dakriotsistit demands performance of a dakriotsistorinostomiya.
Forecast and prevention of trachoma
Timely treatment of trachoma is the main condition of the favorable forecast. About 80% of patients recover within 2-3 months. At the fourth stage of trachoma a recurrence is possible even 5-20 years later. The complicated and recidivous course of trachoma leads to intensive turbidity of a cornea and considerable decrease in sight, up to a blindness.
Refer timely localization of the epidemic centers, identification of sporadic cases, regular medical examination of patients, respect for hygiene to measures of prevention of trachoma.