Trachoma

 

Trachoma

Definition

After years of repeated infection, the inside of the eyelid can become so severely scarred (trachomatous conjunctival scarring) that it turns inwards and causes the eyelashes to rub against the eyeball (trachomatous trichiasis), resulting in constant pain and light intolerance; this and other alterations of the eye can lead to scarring of the cornea. 

Source : WHO 

 

Organ

 

 

Symptoms

Trachoma usually affects both eyes. The conjunctivae (the membranes that line the eyelid and cover the white of the eye) become inflamed, red, and irritated, and the eyes water excessively. The eyelids swell. Sensitivity to bright light occurs.

In the later stages, blood vessels may gradually grow across the cornea (called neovascularization), obstructing vision. In some people, the eyelid is scarred in such a way that the eyelashes turn inward (trichiasis). As the person blinks, the eyelashes rub against the cornea, causing infection and often permanent damage. Impaired vision or blindness occurs in about 5% of people with trachoma.

Source: MSD Manuals 

 

Frequency

It is known to be a public health problem in 42 countries, and is responsible for the blindness or visual impairment of about 1.9 million people. Just over 200 million people live in trachoma endemic areas and are at risk of trachoma blindness.

In 2015, more than 185 000 people received surgical treatment for advanced disease, and 56 million people were treated with antibiotics for trachoma.

Source : WHO 

Causes

Trachoma is the leading infectious cause of blindness worldwide. It is caused by an obligate intracellular bacterium called Chlamydia trachomatis. The infection is transmitted through contact with eye and nose discharge of infected people, particularly young children who harbour the principal reservoir of infection. It is also spread by flies which have been in contact with the eyes and noses of infected people.

In areas where trachoma is endemic, active (inflammatory) trachoma is common among preschool-aged children, with prevalence rates which can be as high as 60–90%. Infection becomes less frequent and shorter in duration with increasing age. Infection is usually acquired when living in close proximity to others with active disease, and the family is the main setting for transmission. An individual’s immune system can clear a single episode of infection, but in endemic communities, re-acquisition of the organism occurs frequently.

Source : WHO

 

Evolution

If this entropion trichiasis is not treated surgically, it causes the appearance of corneal opacities and irreversible blindness.

Translated from WHO

 

Prevention

WHO adopted the SAFE strategy in 1993. Its mandate is to provide technical leadership and coordination to international efforts aiming to eliminate trachoma as a public health problem.

In 1996, WHO launched the Alliance for the Global Elimination of Trachoma by 2020 (GET2020). GET2020 is a partnership which supports implementation of the SAFE strategy by Member States, and the strengthening of national capacity through epidemiological surveys, monitoring, surveillance, project evaluation, and resource mobilization. 

Source : WHO

More information about SAFE and GET2020 : WHO

 

Diagnosis

The diagnosis is made clinically, in an easy manner.

 

Treatment

Surgery to treat the blinding stage of the disease (trachomatous trichiasis).

Antibiotics to clear infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer to elimination programmes, through the International Trachoma Initiative.

Source : WHO

 

 

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