Sign-in
(your email):
(case sensitive):



 
 

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Trachoma


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
076.0 - Trachoma, Initial Stage; Trachoma Dubium
076.1 - Trachoma, Active Stage; Granular Conjunctivitis; Trachomatous: Follicular Conjunctivitis; Pannus
076.9 - Trachoma, Unspecified; Trachoma NOS
139.1 - Late Effects of Trachoma

Related Terms

  • Contagious Granulomatous Conjunctivitis
  • Egyptian Ophthalmia
  • Granular Conjunctivitis
  • Granulomatous Conjunctivitis

Overview

Trachoma is an infectious disease of the eye caused by the bacteria Chlamydia trachomatis. Trachoma is highly contagious, especially in the early stages. It is transmitted from individual to individual by direct contact with eye secretions or through contact with contaminated towels, handkerchiefs, or clothing. Flies attracted to the face and a runny nose can also transmit this disease. The initial infection usually occurs in early childhood and progressive damage happens slowly over the years. By adulthood, repeated infections and progressive scarring can ultimately result in blindness.

Incidence and Prevalence: Trachoma is the leading cause of preventable blindness in the world. About 84 million people worldwide have active trachoma (Mariotti). About 8 million people have lost their vision or have severe vision loss as a result of this disease, and another 500 million are at risk ("Water, Sanitation, & Environmentally-related Hygiene").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The initial infection generally strikes young children (4-6 years age); however, the infection is then easily passed to other family members. Mothers of infected children are at an increased risk (six times higher) for contracting the disease because mothers tend to be the primary caretakers. Extremely poor people who live in crowded conditions in developing countries with poor sanitation (e.g., lack of latrines, problems in controlling the fly population) and no access to clean water, and hence lack of hygiene (dirty face and hands) are at high-risk.

Source: Medical Disability Advisor



Diagnosis

History: An individual may report contact with an infected carrier and may complain of eye (ocular) itching, irritation and mucous or purulent discharge. In more advanced cases, eye pain, light sensitivity (photophobia), blurred vision, the sensation of something in the eye (foreign body sensation), and tearing (lacrimation) may be reported. Some individuals report loss of vision.

Physical exam: The exam may reveal redness (hyperemia) and inflammation of the mucus membrane of the eye (conjunctiva). Small bumps (follicles) may be present (5 or more) on the inner upper eyelid. Individuals with eye pain and foreign body sensation may have a condition in which there is scarring of the inner eyelid, and inward turning of the eyelid (entropion) and of the eyelashes (trichiasis). The inward growing eyelashes rub against the clear, outer layer of the eye called the cornea. If trichiasis is noted, ulcerations, proliferation of blood vessels (neovascularization called pannus), and scarring (clouding) of the cornea may also be observed.

Tests: Due to the lack of testing in endemic areas, the diagnosis of trachoma is usually clinical; however, to confirm the diagnosis, the eye may be swabbed or the cornea scraped to obtain a sample for culture, polymerase chain reaction (PCR) or immunofluorescence techniques if available. There are also in-office test kits that identify Chlamydia species; however, these kits are associated with a high rate of false positives and thus should be done in addition to, rather than in place of, standard bacterial culture.

Source: Medical Disability Advisor



Treatment

Trachoma is easily treated with a single dose of a type of antibiotic (macrolide) taken by mouth (e.g., azithromycin); eye ointment formulations (e.g., tetracycline) may be used instead. Since this infection is so easily spread from individual to individual, it is necessary to treat not only the individual but also anyone with whom they have had close contact (i.e., household members). Simultaneous treatment is necessary to prevent reinfection.

Environmental improvements and good personal hygiene (frequent hand and face washing) are crucial for trachoma control and successful treatment. Towels, clothing, and handkerchiefs should not be reused or shared.

Source: Medical Disability Advisor



Prognosis

If treated early and effectively with the appropriate antibiotic medications, the prognosis for a full recovery is excellent. The predicted outcome worsens with the length of infection and any complications. Untreated or inadequately treated infections cause progressive damage and can ultimately lead to blindness.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Infectious Disease Internist
  • Ophthalmologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Compromised immune system

Source: Medical Disability Advisor



Complications

Complications of trachoma include scarring of the inner eyelid, entropion, trichiasis, pannus formation, drooping eyelids (ptosis), ulceration of the cornea, and progressive scarring (cloudiness) of the cornea that can result in blindness.

Source: Medical Disability Advisor



Factors Influencing Duration

The length of disability is influenced by the severity of the infection and the length of time the infection was untreated. If complications occur, treatment may lengthen the period of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

For a successful recovery, the individual needs to wash his or her hands and face frequently and thus needs easy access to a restroom or washroom. If vision is impaired, tasks requiring close vision, detailed work, or driving should be avoided, and reassignment to less visually intensive work may be required.

Risk: To prevent transmission, close physical contact with others should be avoided until the infection clears. Individuals whose jobs require close contact (e.g., nurses, physicians, daycare providers) may require a leave of absence until the active infection resolves. It is important to treat the individual's family members at the same time as the infected individual to prevent recurrence. In an immune compromised individual, working with heavy public contact, indigent or incarcerated populations, or in health care settings, may place the individual at increased risk of further or recurrent infection. A person with symptom onset within the last 24-48 hours will be at a more infectious state and should avoid working in settings with immune compromised individuals. Some risk can be mitigated by frequent hand washing, gloves, or masks.

Capacity: Capacity is dependent whether vision loss has occurred.

Tolerance: Tolerance varies from individual to individual, and may be improved through frequent face washing and eye ointment application. Worksite accommodations for limited sight during recovery may encourage early return to work.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual present with redness, irritation and discharge from eye?
  • Was corneal scraping done for culture and sensitivity?
  • Was diagnosis confirmed with positive eye culture?
  • If diagnosis was uncertain, were other sources of conjunctivitis or iritis ruled out?

Regarding treatment:

  • Was infection effectively resolved with antibiotic treatment?
  • Has individual become reinfected?
  • Have other individuals who have had close contact with the infected individual been treated?
  • Has individual received instructions about personal hygiene and measures to prevent spread of infection? Has individual been compliant with instructions?

Regarding prognosis:

  • Was infection diagnosed and treated in timely manner? Was individual reinfected through poor hygiene practices?
  • Has individual experienced complications (e.g.,., trichiasis, pannus, ptosis, corneal ulceration, or scarring) due to delayed or inadequate treatment? Are complications being addressed in treatment plan?
  • Does individual have underlying condition, such as a compromised immune system, that may delay recovery?

Source: Medical Disability Advisor



References

Cited

"Water, Sanitation, & Environmentally-related Hygiene." CDC. 28 Dec. 2009. Centers for Disease Control and Prevention. 20 Jul. 2015 <http://www.cdc.gov/healthywater/hygiene/disease/trachoma.html>.

Mariotti, S. P. , et al. "Trachoma: Global Magnitude of a Preventable Cause of Blindness." British Journal of Ophthalmology 93 5 (2009): 563-568.

Source: Medical Disability Advisor