Various Manifestations Of Trachoma In Internally Displaced Rural Population - A Free Eye Camp Based Survey.

BACKGROUND: The objective of the study is to observe frequency of various clinical manifestations of trachoma in rural population. This observational study was conducted at Khalifa Gul Nawaz Teaching Hospital (KGNTH), Bannu, Pakistan from April 2016 to Jan 2017. METHODS: Patients visiting for ocular complaints underwent initial screening that included demographic details and documentation of unaided as well as best corrected visual acuity (BCVA) which was followed by detailed slit lamp examination of anterior segment including eversion of upper lid for assessment of changes in upper tarsal conjunctivas by consultant ophthalmologist. A total of 648 patients who had clinical presentation of trachoma were included in the study. Patients who had other forms of conjunctivitis, trichiasis, entropion, corneal opacification and vascularization due to causes other than trachoma were excluded. Patients were categorized according to age in three groups (Group 1-3) and according to stages of trachoma in five groups (TF, TI, TS, TT and TO). RESULTS: Six hundred and forty-eight (648) were examined in this cross-sectional survey with a mean age of 14.3+14.2 years. Mean unaided visual acuity and BCVA of the patients was 0.12+.24 and 0.07+0.18 respectively. Groups-1 comprised of 86.7% of the patients and stage TF of trachoma was the most prevalent stage accounting for 70.06% of the patients. CONCLUSIONS: Trachoma is a serious community health problem with various clinical manifestations in different age groups. Awareness and educational programs are required to be conducted in schools and vocational training centres regarding its mode of transmission and control..

Conservative management of upper eyelid entropion.

The authors report for the first time two cases of upper eyelid entropion secondary to neonatal conjunctivitis that resolved spontaneously following the insertion of a bandage contact lens. Previous reports advocate early surgical intervention to correct the eyelid abnormality and prevent any permanent corneal scarring and visual loss.

Health-related quality of life in patients with trachomatous trichiasis or entropion.

PURPOSE: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. METHODS: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision = 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. RESULTS: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision = 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. CONCLUSIONS: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.

The association between epilation and corneal opacity among eyes with trachomatous trichiasis.

AIM: To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery. METHODS: Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status. RESULTS: Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated. CONCLUSION: Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.

A contribution to the surgery of the trachomatous entropion and trichiasis.

Although the WHO document WHO/PBL/93.29 recommends the bilamellar tarsal rotation operation for trachomatous entropion, we will describe another operation that has proved to be very reliable. It is a combined method, consisting of the modified tarsal wedge resection and the eversion splinting-grey line incision. A possible additional correction of the grey line incision on the first postoperative day improves the results. A total of 708 eyes with moderate trachomatous entropion and major trichiasis underwent this surgery, but only 508 of these were followed up during a 6-month period. The rate of failed operations, which consisted of incomplete closure of the lids or more than two inverted lashes remaining, was 6.9%.

Distichiasis and dysplastic eyelashes in trachomatous trichiasis cases in Oman: a case series.

The study was a prospective evaluation of the prevalence of distichiasis and/or dysplastic eyelashes among trachomatous trichiasis cases at the oculoplasty unit of a hospital in Oman over 3 months in 2000. An oculoplasty surgeon examined and photographed cases using a bio-microscope. Out of 80 cases, 58 (72.5%) had abnormal eyelashes in addition to trachomatous trichiasis. The rate of distichiasis and dysplastic lashes were 13.8% (95% CI 6.2%-21.3%) and 33.8% (95% CI 23.5%-44.1%) respectively; 25.0% (95% CI 15.5%-34.5%) had both. Dysplastic and distichiasis eyelashes were significantly more prevalent in trachomatous trichiasis cases aged < 50 years and those with entropion. Presence of distichiasis and/or dysplastic eyelashes in trachomatous trichiasis cases warrants further analytical studies to confirm the observation and establish any causal association.

The histopathology and the mechanism of entropion in patients with trachoma.

BACKGROUND: Eyelids of patients with trachoma may be thickened. This thickening could be attributed to trachomatous changes in the conjunctiva and tarsus. METHODS: Biopsies of tarsal plates and palpebral conjunctivae were obtained from 17 upper eyelids of 11 patients with inactive trachoma who underwent posterior tarsotomy procedures for entropion repair. RESULTS: Light microscopy studies showed a thick and compact subepithelial fibrous membrane adherent to the tarsal plate. This membrane caused apparent thickening of the tarsus when measured intraoperatively (range, 1.25-2.00 mm). Other histopathologic findings include atrophy of the meibomian glands with thickening of the acinar basement membrane, loss of goblet cells, retention cysts, and hyaline degeneration of the tarsal plate with focal replacement by adipose tissue. CONCLUSION: The contraction of the subepithelial fibrous membrane formed by vertically oriented parallel collagen fibers is one of the main factors contributing to the entropion formation.