Trachoma

Trachoma is a bacterial infection that infects eyes. It is contagious, spreads through contact with eyes, eyelids and secretions of infected people. It can also spread through infected item such as handkerchiefs.

Trachoma starts with mild itching and then leads to swollen eyelids. Pus may also be present in the eyes.

Trachoma is the leading preventable cause of blindness worldwide. The WHO estimates that about 6 million people have been blinded by trachoma.

It is mostly prevalent among children under 5 years of age. Cases of blindness due to trachoma are mostly reported from poor areas of Africa. Complications can be prevented by early treatment.

Trachoma is characterized by following signs and symptoms:

• mild itching,
• irritation of eyes,
• discharge from eyes containing mucous or pus,
• eyelid swelling,
• light sensitivity and pain the eyes.

According to the WHO there are 5 stages of trachoma:

• Inflammation- follicular. Five or more follicles containing lymphocytes are visible with magnification on the inner surface of upper eyelid.
• Inflammation- intense. This is characterized by thickening or swelling of upper eyelid.
• Eyelid scarring. Repeated inflammation leads to necrosis and is replaced by connective tissue (scarring). At this stage eyelid may become distorted and turn in.
• Ingrown eyelashes (trichiasis). As the eyelid continues to get distorted, the eyelashes also turn in and scratch h the cornea.
• Corneal clouding. At this stage cornea becomes affected by inflammation. In addition, the lacrimal glands can also get affected leading to extreme dryness. Young children are more susceptible to this infection but disease progresses slowly.

Trachoma is caused by chlamydia trachomatis and by its subtypes. Chlamydia is a bacterium that is also the cause of sexually transmitted disease chlamydia.

It spreads through contact with discharge from eyes, nose, hands, clothing and towels of infected person. Insects and eye seeking flies can also act as means of transmission.

The diagnosis of trachoma is usually done by a physical examination. During examination your doctor closely examines the lesions which is usually followed by sending sample of bacteria from the eyes for microbiological testing.

Treatment of trachoma depends on the stage of disease. The following treatment options are available:

• Medications- antibiotics like tetracycline eye ointment or oral azithromycin are effective in eliminating the infection. The WHO recommends to give antibiotics to an entire community when more than 10% of the children are affected by trachoma to prevent spreading.
• Surgery- in eyelid rotation surgery the doctor makes an incision in the scarred eyelid and rotates it back away from the cornea. If the cornea has been affected severely then corneal transplantation is recommended.
• In some cases, removal of eyelashes (epilation) is done. If surgery does not work then it is advisable to place an adhesive bandage over the eyelashes to keep them from touching the eye.

While being treated for trachoma reinfection can occur. Therefore, the following steps must be taken to prevent it:

• Complete screening of family members or others living with a person who has been diagnosed with trachoma.
• Washing face and hands frequently.
• Controlling flies.
• Disposing waste properly and improving access to water.

Special care should be taken in regions like middle east, north Africa, sub-Saharan Africa and areas of southern Africa including china where trachoma is common.

WHO has developed a strategy titled SAFE to prevent trachoma with the goal of eliminating it by 2020.

• S- surgery to treat advanced forms of trachoma.
• A- antibiotic to treat and prevent the infections.
• F- facial cleanliness.
• E- environmental cleanliness.

The following alternative remedies can be useful to relieve symptoms of trachoma:

• Washing the eyes regularly with lukewarm water mixed with borax,
• putting rose water in the eye,
• onion juice and honey used as eye drops.

There are several risks and complications associated with trachoma.

The following risk factors of trachoma are existing:

• poverty,
• crowded living conditions (close contact) poor sanitation,
• women (women are at higher risk of contracting the disease than men).
• flies and lack of latrines.

Trachoma can be easily treated but repeated infections can lead to the following conditions:

• scarring of inner eyelid,
• eyelid deformities (entropion, trichiasis),
• corneal scarring and cloudiness,
• complete loss of vision.