Trachoma/Conjunctivitis is a chronic, infectious disease of the conjunctiva and cornea.

The cause of the condition is a strain of Chlamydia trachomatis. In the early stages, it is easily transmitted by direct contact, contaminated articles, or insect vectors, especially gnats and flies. The incubation period is 5 to 14 days.

The signs and symptoms include: tearing; photophobia; pain; edema of the eyelids; exudate; hyperemia; papillae and follicles on the inside of the upper eyelid; cloudy cornea from vascular invasion; edema of the bulbar conjunctiva; and a tender, preauricular lymph node. All signs of trachoma are more severe in the upper conjunctiva than the lower. In order to establish the actual presence of endemic trachoma in a community, a large number of children must have at least two of the following signs:

• At least five follicles (secretory sacs) on the flat tarsal lining of the upper lid.

• Conjunctival scarring of the upper tarsal lid.

• Limbal follicles.

• Extension of blood vessels onto the cornea, most noticeable at the upper limbus.

Scraping of the conjunctiva may reveal Chlamydial inclusions. However, enzyme assay tests and fluorescent antibody stains are newer tests, and are used more widely for diagnosis.

For systemic treatment, an oral anti-infective is the drug of choice, and the treatment is continued for 3 to 4 weeks. Broad-spectrum antibiotics are alternate choices. It may take several courses of therapy to clear up the infection. Antibiotic eye drops for 6 weeks is equally effective; however, it usually takes 10 to 12 weeks for the full effect to take place. The inturned eyelashes from a late-treated trachoma must be surgically corrected to prevent scarring.

This chronic disease may last for an extended period of time. The condition is known to cause blindness in many parts of Africa, northern Brazil, Asia, and among Australian aborigines.

• Consider entitlement to Auto and auto adaptive equipment under 38 CFR 3.308 if there is permanent impairment of vision in both eyes consisting of central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20° in the better eye.

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• Review for potential entitlement to special monthly compensation under 38 CFR 3.350 when there is loss/loss of use of one or both eyes, light perception only; visual acuity 5/200 or less; the vision field is reduced to 5 degree concentric contraction in both eyes; or blindness with no light perception in one or both eye.

• Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation.

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.