Trachoma (Chlamydia trachomatis serotype A-C) is rare in temperate countries. In endemic regions (warm climates, poor standard of living, and poor hygiene), it is among the most frequent causes of blindness (see Table 4.2 for symptoms, findings, and therapy). Left untreated, the disorder progresses through four stages (Fig. 4.14):

❖ Stage I: Hyperplasia of the lymph follicles on the upper tarsus.

❖ Stage II: Papillary hypertrophy of the upper tarsus, subepithelial corneal infiltrates, pannus formation, follicles on the limbus.

❖ Stages III and IV: Increasing scarring and symptoms of keratoconjunctivitis sicca. The progression is entropion, trichiasis, keratitis, superinfection, ulceration, perforation, and finally loss of the eye.

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