cheap: open the hospital's chloramphenicol (more than 2 dollars), gentamycin eye ointment
moderate: Renshou this kind of (the ingredients are also chloramphenicol, but more than 9 dollars)
better: Zhongxin eye drops, LeDunKang
Once you find the trachoma should be treated in a timely manner. Treatment can be selected topical medication, commonly used eye drops are 0.05% to 0.1% rifampicin, 10% to 30% sodium sulfadiazine acetate, 0.1% phthalidomide, etc., 3 to 4 times a day, and at night with eye ointment once, such as 0.5% tetracycline eye ointment, 0.5% gentamycin eye ointment, etc.. Systemic medication is rarely used because of the long duration and excessive dosage of medication, which is prone to side effects. Sometimes surgical therapy can also be used. Severe trachoma follicles more people, available cuttlebone stick rubbing method and pressure method of treatment, the operation should pay attention to disinfection, rubbing techniques should not be too heavy, do not damage the cornea, the lesion is serious and extensive, can be staged phased rubbing. When the lesion is severe and extensive, the abrasion can be carried out in stages. This method only plays an auxiliary role, and should be combined with medication. Serious trachoma complications, such as trachomatous ptosis, inverted eyelids, lid adhesion, etc., can be corrected surgically. Corneal vascular opacities can be considered for severe cases of corneal limbal vascular electrocautery. Traditional Chinese medicine treatment of this disease, when both internal and external application, mild cases can be local point medicine-based, severe cases in addition to the point of ophthalmic drugs, it is appropriate to cooperate with the internal treatment, in order to clear the wind and heat, blood circulation as the basic treatment
Trachoma, the patient may be self-conscious of the eye itchy, burning sensation, grind the Panic, tearing, etc.
This period is highly contagious, should pay attention to isolation, and should be used to prevent the spread of trachoma. It is highly contagious and should be isolated. What are the dangers of trachoma to the eyes? In addition to invading the conjunctiva, the trachoma organism often invades the cornea, causing many new blood vessels to appear on the cornea, affecting vision and even causing ulcers.
Treatment of trachoma The early stage of trachoma can be cured as long as it is well treated. Early trachoma is mainly to strengthen the local medicine, commonly used sulfonamide eye drops, rifampicin eye drops, etc., 4 to 6 times a day eye drops, before going to bed at night can be coated with some eye ointment, serious can be combined with surgical treatment. Advanced trachoma, mainly for complications, most patients need surgical treatment. Trachoma is a chronic eye disease, need to adhere to the point of medicine, otherwise not only can not cure trachoma, but will make trachoma dependent protozoa resistant
Trachoma (trachoma) is caused by Chlamydia trachomatis (chlamydia) caused by a chronic infectious conjunctival keratitis. It is called trachoma because it forms a rough, uneven appearance on the surface of the lid conjunctiva that resembles grains of sand. The English word trachoma comes from the Greek word trachys, which also means rough and uneven. In the early stage of the disease, there is infiltration of the conjunctiva, such as papillae and follicular hyperplasia, and corneal vascular cataract occurs at the same time; in the late stage, scarring occurs due to the involvement of the lid conjunctiva, resulting in inversion deformity of the eyelid and aggravation of the cornea's damage, which can seriously affect vision and even cause blindness. Before liberation, trachoma was the leading cause of blindness in China. After liberation, under the care of the Party and the government, extensive prevention and treatment of trachoma was carried out. With the improvement of people's living standard and medical and health conditions, the incidence rate of trachoma has been greatly reduced now. As can be seen from the results of the Epidemiologic Sample Survey on Blindness and Low Vision (1988) conducted in Shunyi County, Beijing, as well as in Shanghai, Yunnan, and Shaanxi, the main cause of blindness in most of the above-mentioned areas is due to non-infectious diseases such as cataract and glaucoma. However, the results of the survey in Yunnan Province showed that among the 180,000 patients with double vision blindness in the province, cataract accounted for the first place, about 80,000 people; trachoma and its comorbidities accounted for the second place, about 30,000 people. Therefore, the important position of trachoma in the causes of blindness in China should not be ignored. In addition, this disease is still the main cause of blindness in many developing countries in Asia and Africa.
Diagnosis
Typical trachoma is easier to diagnose clinically based on the presence of papillary and follicular hyperplasia of the lid conjunctiva, corneal vascular opacities and conjunctival scarring. The diagnosis of early trachoma is still difficult. Sometimes it can only be initially diagnosed as "suspected trachoma". According to the decision of the Ophthalmology Branch of the Chinese Medical Association in 1979, the diagnosis of trachoma is based on the following: ① vague vascular congestion of the conjunctiva in the upper domes and the upper eyelid plate, papillary hyperplasia or follicular formation, or both. (ii) Corneal vascular opacities visible by magnification or slit lamp examination. (iii) Scarring of the upper vault or/and upper lid conjunctiva. ④ Conjunctival scraping with trachoma inclusions. Trachoma can be diagnosed by the presence of one of the other three items on the basis of item 1.
Suspected trachoma: conjunctival congestion in the upper dome and canthus, with a small number of papillae (papillae are normal tissue) hyperplasia or follicles, and other conjunctivitis has been ruled out.
Therapeutic measures
Since the application of sulfonamide and antibiotics, trachoma treatment has been significantly carried out. Experimental studies have proved that rifampicin, tetracycline, chlortetracycline, oxytetracycline, erythromycin, sulfonamide and chloramphenicol have inhibitory effects on Chlamydia trachomatis.
1. Topical medication 0.1% rifampicin or 0.5% aureomycin or tetracycline eye drops 3 to 6 times a day, the effect is better. However, such drugs dissolved in water, a few weeks that is gradually failing, need to be reformulated. If made into ophthalmic ointment or suspension can be stored for a longer period of time. 10% ~ 30% sulfacetamide acetylsodium and 0.25% ~ 0.5% chloramphenicol ophthalmic solution is easy to store, the effect is also good. The aforementioned drugs generally need to continue to use 1 to 3 months. Can also be intermittent therapy that is, after 3 to 5 days of medication, stop 2 to 4 weeks, and then use the drug, the effect is also good, easy to adhere to, for most of the keloid and there are still remnants of papillae hyperplasia "islets", can be corroded by copper sulfate pen, to promote the keloid.
2. Systemic therapy Acute or severe trachoma, in addition to local drops of drugs, adults can take oral sulfonamide preparations. Continuous administration of 7 to 10 days for a course of treatment, stop 1 week, can be taken again. Need 2 ~ 4 courses of treatment, should pay attention to the side effects of the drug.
3. Surgical treatment nipple hyperplasia serious, feasible drug friction, with a cotton swab or cuttlebone stick dipped in octopus stick dipped in sulfa or tetracycline, rubbing eyelid conjunctiva and dome conjunctiva. If there are many follicles, squeeze the follicles under local anesthesia with wheeled forceps to discharge their contents, while combining medication to promote healing. To eliminate the sequelae of the eye, such as a few inverted eyelashes, feasible electrolysis, eyelid inversion inverted eyelashes, need to be surgically corrected.
Aetiology
The secretion of trachoma can infect this disease, which has been known for a long time. 1907 Halberstaedter and Von Prowazek used light microscope and Giemsa staining, and found that inclusion bodies in the conjunctival epithelial cells of trachoma, i.e., there are reddish-blue progenitors in the epithelial cells and dark-blue granules of the initiating body are aggregated, and the inclusion bodies have a matrix, which is quite similar to that of the conjunctival epithelium. （In 1954, Tang Feifan and Zhang Xiaolou collaborated in the examination and treatment of a large number of patients, took the patients' eye secretions to inoculate the monkey eyes, and inoculated the monkey eyes with the secretions of the trachoma patients. At the same time, the secretions of trachoma patients were inoculated into the brain of mice, but the results were completely negative. 1955, we changed to use chicken embryo inoculation, and pay attention to the selection of active, uncomplicated and untreated trachoma cases, using streptomycin to kill the bacteria in the specimen, and finally the first isolation of the culture was successful in 1956. From then on, a new wave of trachoma research was set off in the world. Because this pathogen can pass through the bacterial filter, parasitized in the cell, and the formation of inclusion bodies, so at that time is considered to be a virus. It was also recognized that its size and shape were different from general viruses, and was called atypical or large virus. Later, scholars from various countries further studied its molecular biology and metabolic functions, proving that it has RNA and DNA and certain enzymes, reproduces in a bifurcated manner, has a cell membrane and wall and is sensitive to antibiotics, etc., which are not in line with the basic properties of viruses. In 1971, Storz and Page proposed to create a new class of microorganisms called Chlamydia, which was accepted by the Bergey Manual of Bacterial Identification published in 1974: it was classified in the Prokaryota, Thin-walled Bacteria, Rickettsia, Chlamydia, Chlamydiaceae, Chlamydiaceae, Chlamydiaceae, Chlamydiae, Chlamydiae, Chlamydiae Species, including Chlamydia Trachomatis, Chlamydia conjunctivitis, and Chlamydiae psittaci. Chlamydia species and Chlamydia psittaci. the 10th edition of the handbook, published in 1989, added Chlamydia pneumoniae. Chlamydia trachomatis conjunctivitis is subdivided into three biovariants: trachoma, lymphogranuloma, and murine pneumonia. The trachoma variant is divided into 12 immunotypes, including A, B, Ba, C, D, E, F, G, H, I, J, and K, and the lymphogranuloma variant is divided into three immunotypes, including L1, L2, and L3.
Generally speaking, most of the endemic blinding trachoma is caused by A, B, Ba and C types, and some roles say that these types are mostly caused by the epidemiological Chlamydia trachomatis group; while the D to K types mainly cause genitourinary infections; such as urethritis, cervicitis, epididymitis, etc., as well as inclusion body conjunctivitis, so that it is called ocular - genitourinary group of Chlamydia. 1966, Wang Kekqian and Zhang Xiaolou in our country adopted the mouse toxin protection test. In 1966, Wang Keqian, Zhang Xiaolou and others used the mouse toxin protection test to classify 46 species of Chlamydia trachomatis isolated in different regions of China during 10 years into two immunotypes Ⅰ and Ⅱ, with TE-55 samples as the representative of type Ⅰ, and TE-106 samples as the representative of type Ⅱ, and the ratio of the two types was 2:1. However, the correspondence between type Ⅰ and Ⅱ, and the above mentioned 15 species of Chlamydia trachomatis immunotypes has never been certain. Zhang Li, Zhang Xiaolou et al. (1990) used Micro immunofluorescence Test to detect Chlamydia trachomatis immunotypes in trachoma-endemic areas of North China, and the results showed that trachoma epidemics in North China were dominated by type B, followed by type C. The results of the Micro immunofluorescence Test showed that Chlamydia trachomatis immunotypes were mainly found in trachoma epidemics of North China.
Chlamydia trachomatis can infect human conjunctival and corneal epithelial cells. In its life cycle, there are two biological phases: the protozoa (elementary body) is the infectious phase, the size of about 0.3 μm, with a cell wall, can survive outside the cell; the initial body (initial body), also known as reticulate body (reticulate body) is the reproduction phase, the volume is larger, about 0.8 μm, non-infectious. After invasion of the host cell, the progenitor develops and transforms into the initial body in the cytoplasm, and forms the zygotic progenitor by bifurcation. When the cytoplasm fills up, it ruptures and releases the progenitor, and the free progenitor then invades normal epithelial cells to start a new cycle. Each cycle lasts about 48 hours.
Trachoma is a primary infection that can heal without scarring. However, in endemic areas with poor sanitation, repeat infections often occur. The primary infection has sensitized the conjunctival tissue to Chlamydia trachomatis, and when it meets Chlamydia trachomatis again, it causes a delayed hypersensitivity reaction. Trachoma in the chronic course of the disease, there are often acute episodes, may be the manifestation of repeated infections. Multiple repeated infections aggravate the original trachoma vascular opacities and scar formation, and even lid hypertrophy and deformation, causing lid inversion and impingement, aggravating corneal clouding, impairing vision, and even blindness. In addition to repeated infections, the combination of other bacterial infections also aggravates the condition.
Pathological changes
Chlamydia trachomatis only invades the epithelial cells of the lid conjunctiva and the conjunctiva of the dome, but the pathological changes caused by it reach the deep tissues. First, the superficial epithelial cells show degeneration and shedding, while the deeper ones proliferate, and as the disease progresses, the epithelial cells proliferate rapidly, so that the epithelial layer is no longer smooth, and a papilla is formed. The substance of the papilla contains dilated microvessels, lymphatic vessels and lymphocytes. At the same time, the subepithelial tissue of the conjunctiva undergoes diffuse lymphocytic infiltration with limited localized aggregation to form follicles. The follicles are centrally populated with lymphoblasts, macrophages, and reticulocytes, and are surrounded by a large number of small lymphocytes. As the disease progresses, the follicles undergo degeneration and bilharzia, followed by connective tissue hyperplasia and scarring. The lids are also hypertrophied by diffuse lymphocytic infiltration, and in severe cases, connective tissue hyperplasia deforms the lids. Corneal vascular opacities start from the upper corneal limbus, with corneal microvascular dilatation and progression to the central part of the cornea, accompanied by cellular infiltration, initially located in the superficial layer, and then to the lower and deeper layers of the cornea. At first, the cornea was draped, and in severe cases, the entire cornea could be invaded.
Clinical manifestations
The incubation period is about 5 to 12 days. Usually invades both eyes. Most often occurs in children and adolescents.
1. Symptoms Mostly acute onset, the patient has a foreign body sensation, photophobia, tearing, and a lot of mucus or mucous secretions. A few weeks after the acute symptoms subside, into the chronic phase, at this time may not have any discomfort or only feel easy eye fatigue. If cured at this time or self-healing, can not leave a scar. However, in the chronic course of the disease, in endemic areas, there are often repeated infections, the disease is aggravated. When there is active vascular cataract on the cornea, the irritation becomes significant and the vision is reduced. In the late stage, the symptoms are often more pronounced due to sequelae, such as lid entropion, inverted eyelashes, corneal ulcers and eye dryness, and severely affect vision, even blindness.
2. Signs
1) Acute trachoma: acute follicular conjunctivitis symptoms, lid redness and swelling, conjunctiva highly congested, due to papillary hyperplasia lid conjunctiva rough and uneven, upper and lower dome part of the conjunctiva full of follicles, combined with diffuse corneal epitheliitis and pre-auricular lymph node enlargement. The acute inflammation subsided after a few weeks and turned into a chronic phase.
(2) chronic trachoma: can be due to repeated infections, the course of the disease delayed for several years to more than a decade. Although the degree of congestion is reduced, but with the subcutaneous tissue has a diffuse cellular infiltration, the conjunctiva is dirty and hypertrophic, at the same time, there are papillary hyperplasia and follicle formation (Figure 1), follicles of varying sizes, can be gelatinous, the lesion on the dome and the upper edge of the eyelid plate conjunctiva significant. The same lesion is also seen in the lower lid conjunctiva and lower vault conjunctiva, and in severe cases, it may even invade the wall of the semilunar folds. Corneal vascular opacity: it is caused by the normal capillary network outside the corneal limbus, crossing the corneal limbus into the transparent cornea, affecting the vision and gradually developing towards the pupil area, accompanied by cellular infiltration and development of small shallow ulcers, which can form a small surface of the cornea after healing. The cellular infiltration is severe enough to form hypertrophic fleshy vascular opacities (pannus crassus).
Figure 1 Trachoma follicles
In the chronic course of the disease, the lesions of the conjunctiva are gradually replaced by connective tissue, forming a scar. The earliest appearance is in the subglabellar sulcus of the conjunctiva of the upper eyelid in the form of a horizontal white streak, which gradually takes on a reticular shape, and by the time the active lesion has completely subsided, the entirety of the diseased conjunctiva has become a white, smooth scar (Fig. 2).
Figure 2 Trachoma scar
The course and prognosis of trachoma varies depending on the severity of the infection and whether it is recurrent. In mild cases or those without recurrent infections, the disease resolves in a few months, leaving a thin or no visible scar on the conjunctiva. Repeated infections of severe patients, the course of the disease can linger for several years to more than a decade, chronic disease, can be infected by other bacteria and repeated infections are often acute episodes. Finally, extensive scarring is no longer infectious, but there are serious complications and sequelae, often making vision loss, or even blindness.
In order to prevent and treat trachoma and the need for investigation and research, there are many clinical staging methods for trachoma. China's second national ophthalmology academic conference in 1979, the discussion, re-established the staging of trachoma:
I stage - progressive stage: that is, the active stage, papillae and follicles at the same time coexist, the upper dome of the conjunctival tissues are blurred, there are corneal vascular opacities.
Stage II - regressive stage: from the beginning of the appearance of scarring to the time when most of it becomes scarred. Only a few active lesions remain until the end.
Stage III - complete scarring: the active lesion disappears completely and is replaced by a scar, which is not infectious.
The criteria for grading were also developed: according to how much of the total area of the upper lid conjunctiva is occupied by active lesions (papillae and follicles), it is divided into two levels: light (+), medium (++), and heavy (++++). Those accounting for less than 1/3 of the area are (+), those accounting for 1/3 to 2/3 are (++), and those accounting for more than 2/3 are (++++).
And the grading method of corneal vascular opacities was determined: the cornea was divided into four equal parts, and the vascular opacities invading the upper ? Those who are within (+), those who reach ? ~1/2 is (++), those reaching 1/3 to 3/4 is (++++), and those exceeding 3/4 is (++++) (Figure 3).
Figure 3 Corneal vascular opacities
1. Normal blood vessels do not invade the clear cornea 2. vascular opacities (+)
3. vascular opacities (+++) 4. vascular opacities (++++) 5. vascular opacities (++++)
Internationally, the more generalized is the MacCallan staging method:
Stage I - -Early infiltration: the lid conjunctiva and the dome conjunctiva are congested and hypertrophied, especially above, and there may be initial follicles and early corneal vascular opacities.
Stage II - active stage: there are obvious active lesions, i.e. papillae, follicles and corneal vascular opacities.
Stage III - pre-scarring: same as our stage II.
Stage IV - complete scarring stage: same as our stage III.
Differential diagnosis
1. Conjunctival folliculosis (conjunctival folliculosis) is common in children, are bilateral, no conscious symptoms. The follicles are mostly found in the lower dome and lower lid conjunctiva. The follicles are small, uniformly similar in size, translucent, and clearly demarcated, and the conjunctiva between the follicles is normal, not congested, with no corneal opacities and no scarring. The follicles of trachoma are mostly found in the upper dome and upper lid conjunctiva, which are cloudy, unequal in size, irregularly arranged, and have symptoms such as conjunctival congestion and hypertrophy.
2. Chronic follicular conjunctivitis (chronic follicular conjunctivitis) is common in school-age children and adolescents, all of which are lateral, and B. granulosis may be the cause. There is often a morning discharge and ocular discomfort. Follicles are mostly found in the lower vault and lower lid conjunctiva, uniform in size and neatly arranged; the conjunctiva is congested but not hypertrophied; it heals spontaneously after 1-2 years without scar formation; there is no corneal vascular opacification.
3. Spring conjunctivitis (vernal conjunctivitis) This disease is seasonal, and the main symptom is itching. The papillae on the lid conjunctiva are large, flattened and hard, and there is no lesion on the superior fornix, making it easy to identify. Eosinophilia is seen in the secretion smear.
4. inclusion conjunctivitis (inclusion conjunctivitis) adult and neonatal inclusion conjunctivitis in the conjunctival scraping can be seen in the inclusion body, its morphology and trachoma inclusion body is the same, it is difficult to distinguish. However, inclusion body conjunctivitis begins acutely, and the follicles are found in the inferior colliculus and lower lid conjunctiva without corneal opacification, and can heal spontaneously in a few months to a year without scarring, which can be differentiated from trachoma.
Prevention
Chlamydia trachomatis is often found in the secretions of the patient's eyes, and any contact with these secretions can lead to the spread of trachoma infection.
Therefore, publicity and education should be strengthened to spread the knowledge of prevention and treatment of eye diseases to the public and implement the policy of prevention. Cultivate good hygiene habits. Do not rub your eyes with your hands, towels, handkerchiefs should be washed and dried; nurseries, schools, factories and other collective units should be divided into pots and towels or running water to wash their faces, trachoma patients should be actively treated, strengthen the barber's office, bathrooms, hotels and other service industries of the hygiene management, strict disinfection system of towels, basins, etc. and pay attention to the cleanliness of the water source.