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Trachoma

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Trachoma is an infectious eye disease caused by the bacteria Chlamydia trachomatis and is the leading cause of infectious, preventable blindness in the world. An estimated 84 million are infected with these bacteria and as a result, 8 million have visual impairment resulting from this disease. Infection is easily passed from person to person and is even more prevalent in places where there crowded living conditions. Treatment of trachoma often goes beyond medication of an individual but also often involves improving living conditions and environmental quality to prevent recurrence of the disease.

TRACHOMA SIGNS AND SYMPTOMS

The infection is usually acquired during childhood, and if left untreated can become chronic and will turn the eyelids inward, causing the eyelashes to scratch the surface of the cornea. This causes excruciating pain and scarring on the eye, and will cause the cornea to cloud over, leading to blindness at the ages of around 30 to 40.

Conjunctivitis occurs after a 5 to 12-day incubation period of the bacteria Chlamydia trachomatis. Initially this is infection is called an active trachoma and is common with infants and school children. Repeated episodes of this infection are causes the further development of this disease and maintains the inflammation of the eye. White lumps may be found on the underside of the eyelid and the intense irritation can cause watery discharge. Follicles may also be found on the sclera or the white portion of the eye. Further bacterial infections may also occur at this point, producing their own discharge.

The infection can further proceed in to what is called cicatricial trachoma. Repeated infections will begin to scar the eyelid and will lead to the distortion of the eyelid. This will cause the eyelashes to turn inwards and begin rubbing against the surface of the eye. This condition is known as trichiasis. Repeated scarring will eventually cloud the cornea and affect vision. If left untreated, this condition can completely cloud over the cornea and lead to blindness.

Other symptoms include eye discharge, swollen lymph nodes near the eyes, and complications in the ear, nose and throat area.

TRACHOMA CAUSES

Trachoma is caused by the infection of the eye by the Chlamydia trachomatis bacteria. The bacteria are transferred via contact with discharge from the eyes and nose of infected individuals. The bacteria can also be transferred by sharing utensils, towels and other personal objects. Risk factors which increase transmission of this disease include poor sanitation, crowded living conditions and poor access to clean water. In such cases, poor hygiene can easily aggravate the infection while close proximity of infected individuals to others can easily transfer the bacteria from one person to another. Flies also increase the transmission by acting as a vector, transferring the bacteria from one person to another. They can also aggravate existing trachoma infection with their own bacteria.
Trachoma
Image: Trachoma


A classification system for trachoma cases based on severity of cases has been devised by the World Health Organization or WHO. Trachomatous inflammation, described as follicular (abbreviated as TF) is assigned to cases where there are at least 5 follicles larger than 0.5mm on the upper conjunctiva. Trachomatous inflammation, described as intense (TI) involves papillary hypertrophy and further swelling and thickening of the conjunctiva. Trachomatous trichiasis (TT), the next category, is characterized by the presence of at least one eyelash touching the surface of the eye itself and evidence of eyelash follicle loss. Trachoma cases where evidence of corneal blurring can already be seen due to contact with the eyelashes are classified under corneal opacity (CO)

TRACHOMA TREATMENT

To treat trachoma, the World Health Organization recommends using either using oral dosages of azithromycin or topical eye ointment containing tetracycline. Azithromycin is more effective in combating the infection, but it is more expensive that the tetracycline ointment. Azithromycin is preferred as results can be easily measured with a single dose, and changes to the dose can be administered much quicker. Its effects are more consistent and has good efficacy while having a low incidence of adverse side effects. If side effects do occur however, the worst one can experience is an upset stomach or rash that may develop. Resistance of C trachomitis to either antibiotic has not been observed and the two antibiotics remain effective in fighting the infection and preventing the progression of the disease.

Aside from the use of these drugs, the proper administration of these medications is also essential. Often times the immediate family may require to go on a specific targeted treatment even if only one member has trachoma to reduce C trachomitis levels among them. This is done to reduce the chance of the infection occurring again.

Eyelid surgery may be necessary for individuals who are already experiencing eyelid deformation as a result of advanced trachoma. Since the eyelashes have pointed inward and continue to irritate the surface of the eye, corrective surgery is done to realign the eyelashes outward to stop further irritation. However, surgery does not eliminate the risk of recurring infections and as the wound heals, the doctor should follow up the surgery and antibiotics may be required to keep infections at bay.


Sanitation goes a long way in preventing the spread of trachoma. Frequent hand and face washing prevents people from spreading the bacteria via direct contact. Thus it is essential for impoverished communities to have access to clean running water. Proper waste management also reduces the presence of C trachomitis bacteria that may cause infections but also reduce fly populations that can act as vectors in the spread of trachoma. The construction of proper latrines can reduce fly populations much more effectively than insecticides, as flies prefer to lay their eggs on human feces.

TRACHOMA PREVENTION

Also, to avoid infecting the eyes, avoid using your bare hands for rubbing itchy eyes to prevent dirt and bacteria from entering the eyes and causing further infection. It is better wash it out with clean water or use a clean towel. Also, avoid sharing clothes, beddings, toiletries and towels as these may spread C trachomitis on their surfaces.
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