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Australian Trachoma Surveillance Report 2013

Appendix 1. WHO trachoma grading card

Page last updated: 2015

Appendix 1 is the World Health Organisation Trachoma Grading Card with 6 pictorial images showing: normal tarsal conjunctiva; Trachomatous inflammation – follicular (TF); Trachomatous inflammation – follicular and intense (TF + TI); Trachomatous scarring (TS); Trachomatous trichiasis (TT); Corneal opacity (CO). 
Picture 1: World Health Organisation Trachoma Grading Card with 3 pictorial images showing: Each eye must be examined and assessed separately Use binocular loupes (x2.5) and adequate lighting (either daylight or a torch) Signs must be clearly seen in order to be considered present. image 1. The eyelids and cornea are observed first for inturned eyelashes and any corneal opacity. The upper eyelid is then turned over (everted) to examine the conjunctiva over the stiffer part of the upper lid (tarsal conjunctiva). The normal conjunctiva is pink, smooth, thin and transparent. Over the whole area of the tarsal conjunctiva there are normally large deep-lying blood vessels that run vertically image 2. Trachomatous Inflammation- Follicular (TF): The presence of five or more follicles in the upper tarsal conjunctiva. Follicles are round swellings that are paler than the surrounding conjunctiva, appearing white, grey or yellow. Follicles must be at least 0.5mm in diameter, i.e., at least as large at the dots shown, to be considered. images 3. Trachomatous Inflammation-Intense (TI): Pronounced inflammatory thickening of the tarsal conjunctiva that obscures more than half of the normal deep tarsal vessels. The tarsal conjunctiva appears red, rough and thickened. There are usually numerous follicles, which may be partially or totally covered by the thickened conjunctiva.   
Picture 2: World Health Organisation Trachoma Grading Card with 3 pictorial images showing: Image 4. Trachomatous scarring (TS); the presence of scaring in the tarsal conjunctiva Scars are easily visible as white lines, bands or sheets in the tarsal conjunctiva. They are glistening and fibrous in appearance.  Scarring, especially disfuse fibrosis, may obscure the tarsal blood vessels. Image 5. Trachomatous trichiasis (TT); at least one eyelash rubs on the eyeball.  Evidence of recent removal of inturned eyelashes should also be graded as trichiasis. Image 6. Corneal opacity (CO): easily visible corneal opacity over the pupil.  The pupil margin is blurred viewed through the opacity.  Such corneal opacities cause significant visual impairment (less than 6/18 or 0.3 vision) and therefore visual acuity should be measured if possible.

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  • Table of contents
  • List of figures
  • List of tables
  • Acknowledgments
  • Technical terms and definitions
  • Abbreviations
  • Executive summary
  • Background
  • Methodology
    • Data analysis
  • National results 2013
  • Northern Territory results
  • South Australia results
  • Western Australia results
  • New South Wales results
  • Discussion
  • Reference list
  • Appendices
    • Appendix 1. WHO trachoma grading card
    • Appendix 2. Trachoma surveillance summary forms
      • Active cases of Trachoma
      • Treatment of household contacts
      • Data Collection Form—Trichiasis
      • Data collection form—Health Promotion
    • Appendix 3. De-identified community trachoma prevalence trends by regions, Australia, 2007-2013

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