Subtarsal fibrosis
 

Subtarsal fibrosis in trachoma Corneal opacities in trachoma

. Trachoma is uncommon in the UK. However, in the examination you may be given patients who acquire the disease in their  home countries. Always ask to examine the undersurface of the upper lid if you found upper lid entropion and/or diffuse  corneal opacities especially if the patients were non-white. There are diffuse corneal opacities (sometimes with vascularization) in both eyes and/or bilateral upper entropion. The  inferior fornix is deep and there are no symblepharons (the presence of symblepharon should make one consider ocular  cicatricial pemphigoid, Steven-Johnson's syndrome or chemical burnt injuries). On everting the eyelids, there are subtarsal  fibrosis. Other features that may suggest trachoma: micropannus in the superior cornea pits at the limbus (Herbert's pits which results from necrosis of the follicles)

Questions:

1. How does trachoma cause blindness?

Answer
Through corneal scarring from keratitis and entropion.

2. What are the differences between trachoma and adult inclusion conjunctivitis?

Answer
Although both conditions are caused by Chlamydia trachomatis. Trachoma is transmitted by flies and caused by serotypes A, B, Ba or C. It is commonly seen in tropical countries where sanitation is poor. Adult inclusion conjunctivitis is caused by serotypes D, E, F, G, H, I, J or K, it is common in developed countries and the condition is usually transmitted sexually.

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