2. Trachomatous inflammation intense (TI)
Introduction
Along with TF this sign represents the active, infective, or inflammatory stage of trachoma.
TI provides information about the severity of trachoma in an individual or a population. When observing the everted eyelid, one should first look for the presence of five follicles and make a decision regarding the presence or absence of TF.
Once this is done a decision regarding the TI sign should be made. Again, signs should only be considered if they lie within the grading area.
Trachomatous inflammation intense (TI)
Definition
Pronounced inflammatory thickening of the upper tarsal conjunctiva that obscures more than half of the normal deep tarsal vessels. It is characterised by a thickened velvety appearance of the conjunctiva.
Figure 8: Note deep tarsal vessels running in a vertical pattern, in the grading area.
Figure 9: Trachomatous inflammation intense (TI).
The important component of this diagnosis is the thickened velvety appearance of the conjunctiva. It is a common trap to worry more about obscured vessels, however vessels may be blocked by other pathology particularly scarring.
Only obstruction of the vessels by a thickened, inflamed conjunctiva should be considered TI. It is also important to look for the thickened oedematous conjunctiva not just a conjunctiva with a red appearance.
Figure 10: Vessels obscured by scarring.
This is not trachomatous inflammation intense (TI), despite the fact that no vessels are visible.