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Trachoma

Generality/Definition
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    Trachoma is the leading infectious cause of ocular morbidity. This disease is a chronic keratoconjunctivitis caused by the obligate intracellular bacterium Chlamydia trachomatis. Repeated episodes of reinfection within the family cause chronic follicular or intense conjunctival inflammation (active trachoma), which leads to tarsal conjunctival scarring. The scarring distorts the upper tarsal plate and, in some individuals, leads to entropion and trichiasis (cicatricial trachoma). The end result includes corneal abrasions; corneal scarring and opacification; and, ultimately, blindness.
    Source: Provisu look Trachoma (emedicine.com)

Epidemiology

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    Trachoma affects about 84 million people of whom about 8 million are visually impaired. It was once endemic in most countries. It is responsible, at present, for more than 3% of the world's blindness but the number keeps changing due to the effect of socio-economic development and current control programmes for this disease. In spite of this, trachoma continues to be hyperendemic in many of the poorest and most remote poor rural areas of Africa, Asia, Central and South America , Australia and the Middle East. The sequellae of active trachoma appear in young adulthood and in middle-aged persons. In hyperendemic areas active disease is most common in pre-school children with prevalence rates as high as 60-90%. It often strikes the most vulnerable members of communities--women and children. Adult women are at much greater risk of developing the blinding complication of trachoma than are adult men. This increased risk has been explained by the fact that women generally spend a greater time in close contact with small children, who are the main reservoir of infection.
    Source: Provisu look WHO | VISION 2020 priority eye diseases (iapb.org)
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Prevention

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    Environmental risk factors are water shortage, flies, poor hygiene conditions, and crowded households. A prolonged exposure to infection throughout childhood and young adulthood appears to be necessary to produce the complications seen in later life. A single episode of acute Chlamydial conjunctivitis is not considered sight threatening as there is virtually no risk of prolonged inflammation or blinding complications.
    Source: Provisu look WHO | VISION 2020 priority eye diseases (iapb.org)

Symptoms

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    Tearing, pain, swollen eyelid, and corneal inflammation are some of the first symptoms. As the disease progresses, it leads to scratching of the eyelids. Eventually, scars develop over a period of time, leading to blindness.
    Source: Provisu look Trachoma (uniteforsight.org)

Diagnosis

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    Active trachoma is characterized by a mucopurulent keratoconjunctivitis. The conjunctival surface of the upper eyelid shows a follicular and inflammatory response. The cornea may have limbal follicles, superior neovascularization (pannus), and punctate keratitis. Infection with C trachomatis concurrently occurs in other extraocular mucous membranes, commonly the nasopharynx, leading to a nasal discharge.
    Source: Provisu look Trachoma (emedicine.com)

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Last modified: Jan 2014
Creation: Jan 2006