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Trachoma - an Easily Preventable Blinding Disease

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Trachoma - an Easily Preventable Blinding Disease

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Trachoma is a preventable blindness and infection of the eye associated with a bacteria called Chlamydia. Read the article to know more.

Medically reviewed by

Dr. Preetha. J

Published At August 17, 2018
Reviewed AtDecember 29, 2023

What Is Trachoma?

Trachoma is a severe infectious follicular conjunctivitis frequently seen in developing countries. It affects children aged five to ten years, with complications starting from 20 to 30 years. In severe cases, it is known to cause a variety of eyelid malformations by its tendency to produce scarring. It is a major public health problem and deserves attention from the common man in terms of preventive measures to be taken and hygienic practices to be followed and city planners and executives, as sanitation and hygiene are the major factors responsible for this disease.

The World Health Organization (WHO) has created a mission to eliminate trachoma by 2020 through various innovative public health strategies known as S.A.F.E.

  • S- Surgery to correct the advanced, blinding stage of the disease (trichiasis).

  • A- Antibiotics to treat an active infection.

  • F- Facial cleanliness.

  • E- Environmental improvements in water and sanitation to reduce disease transmission.

What Are the Causes of Trachoma?

Trachoma is caused by Chlamydia trachomatis, a bacteria that is gram-negative with a life cycle tailormade to evade our natural immune defense mechanisms. The infective form of this organism called an elementary body, is an inert, tough protective shell harboring the infectious organism. Through this form, chlamydiae are capable of surviving extreme conditions that would generally instantly kill the organism. After gaining entry into our body, the elementary body infects our bodily cells by endocytosis, which coats itself with the cells' own coating and starts multiplying inside. During this whole process, the organisms are protected from our immune protective mechanisms through a variety of countermeasures by the organism. Once inside the cell, the elementary body becomes active, transforms into a reticular body, and starts multiplying within the host cell until the host cell can no longer sustain the multiplication rate of these infectious bodies. The reticular bodies once again transform into elementary bodies before rupturing the host cell, infecting another cell, and continuing the same cycle all over again.

What Are the Stages of Trachoma?

Trachoma comprises of two stages:

The Active Phase:

The active phase shows follicular conjunctivitis as a feature. The diagnosis is completely based on the clinical appearance of active trachoma in a community where trachoma is endemic or suspected to be endemic. Usually, patients with active trachoma are asymptomatic or present with the only symptom of follicular conjunctivitis.

The Scarring (Cicatricial) Phase:

The scarring or cicatricial phase has special clinical features, which lead to definitive diagnosis in most cases. Conjunctival scarring alone can be asymptomatic. However, the tear film's structure changes due to the destruction of mucous and serous glands, often leading to dry eye. Both phases can coexist in the same patient and may not follow a linear pathway of disease pathogenesis.

What are the Symptoms and Signs of Trachoma?

1. In Milder Forms -

a. Follicles - These are the proliferation of lymphoid cells as an immune reaction to the spread of chlamydia. This is the earliest and most characteristic sign. At this stage, the disease can be easily reversed and will not cause any permanent damage to the patient’s eye.

b. Severe Inflammation - The eye becomes red and starts to water. This is also a feature seen in early disease and should raise an alarm that the condition needs to be urgently treated.

2. In Severe Forms -

a. Scarring - In this stage, the inflamed and reactive tissues have been replaced by scar or dead tissues. This indicates a stage of irreversibility, and the tissue, once scarred, does not regain its normal elasticity and function. The scarred tissue is relatively rigid and non-malleable and gives rise to complications of the lid, such as the inward turning of eyelid margins.

b. Trichiasis - In more severe forms of scarring, the inward-turned eyelashes will rub against the cornea, grating it to cause erosions and ulcers. If not treated properly, these ulcers and erosions will lead to the formation of permanent corneal opacification, thus blinding the patient for life. The only cure for such blindness is surgery, and the outcomes of the surgery are not 100 % good; that is, not all patients improve with surgery.

How Can Trachoma Be Treated?

The treatment of trachoma includes the S.A.F.E. strategy developed by the WHO.

Surgical Care:

  • In order to correct trichiasis, eyelid surgery is a must in people with trichiasis who are at a higher risk for trachomatous blindness.

  • Eyelid rotation stops the progression of corneal scarring, and in some cases, it can result in a slight improvement in visual acuity.

Antibiotic Therapy:

The W.H.O. has recommended two antibiotics for trachoma control:

  • Oral Azithromycin (Azithromycin eye drops have also been proved to be effective against the infection. Azithromycin is the drug of choice as it is easy to administer as a single oral dose.Its administration can be observed directly).

  • Tetracycline eye ointment.

Adverse effects, if any, are usually mild such as gastrointestinal upset or rash. The infection usually involves the nasopharynx. Therefore, there are chances of reinfection if only topical antibiotics are used.

Facial Cleanliness:

Various studies and trials have shown that facial cleanliness in children reduces the risk and severity of this infection.For the successful elimination of trachoma, health education and prevention activities must be promoted.

Environmental Improvement:

Improvements in personal and community hygiene are most important to reduce the prevalence and eliminate trachoma. Environmental improvement can be achieved by improving water supplies and household sanitation, including methods for safely disposing of human feces.

Preventive Measures:

The disease of trachoma is an easily preventable one and can be avoided by the following measures.

Stop Eye Rubbing - This is a relatively simple way to avoid infections from getting into the eye. The main mode of spread is from bodily secretions, as previously mentioned. Hence, the organism's mode of entry into the eye is by contact of the eye with the hands. Once eye rubbing is avoided, the organism has no way to gain access to the ocular surface and hence effectively prevents the infection.

Maintaining Hygienic Practices - Regular handwashing has been shown to drastically reduce the transmission of not only trachoma but also many other ocular viral and bacterial infections. Hand washing often and especially before greeting others, is the main mode to prevent the spread of trachoma.

Facial Hygiene - This prevents the transmission of infection by flies and airborne insects which harbor the infection and transmit it by contact. So, maintain facial hygiene with regular bathing and face washing with soap and water.

Public health measures include using toilets for defecation rather than in the open air and promoting hygiene of the surroundings by preventing stagnation of sewage water and garbage dumps.

This disease is seen in most parts of the world, and it is common among the poor and uncared. A few measures of personal hygiene and respect for our environment can go a long way in preventing this transmissible cause of blindness.

Conclusion:

Trachoma is the world’s leading infectious cause of visual impairment or blindness. Trachoma is a recurrent ocular infection caused by Chlamydia and is endemic in the developing world. It causes inflammation of the cornea and conjunctiva (keratoconjunctivitis) resulting from the obligate intracellular bacterium Chlamydia trachomatis.Poor sanitation, crowded living conditions, and insufficient clean water and toilets can lead to an increased risk of trachoma.

Long-term follow-up should be done for patients with the active or cicatricial disease. In addition, screening should be done in all women younger than 25, pregnant women, and women at increased risk of infection.

Frequently Asked Questions

1.

Can Trachoma Be Prevented?

Trachoma can be prevented by either avoiding or modifying certain aspects of the immediate environment and removing the risk factors. Some of the means to be adopted are:
- Regular face and hand washing.
- Controlling fly populations.
- Proper waste management.
- Access to clean water sources.
- Avoiding crossed households.
- Maintaining proper hygiene.

2.

Can Trachoma Cause Blindness?

Trachoma is a bacterial infection caused by the bacterium Chlamydia trachomatis. It has been seen in over 44 countries worldwide, with an estimated 1.9 million people suffering from trachoma-induced irreversible blindness or visual impairments

3.

Which Type of Trachoma Is Referred to as the Blinding Type?

Various different types of bacterium C. trachomatis are found in the environment, out of which types A, B, Ba, and C are the ones responsible for blindness. Other stains of the bacterium mainly cause STDs (sexually transmitted diseases). Unfortunately, blindness caused by this bacteria is irreversible in nature.

4.

Which Are the Most Common Reasons for Blindness?

The leading causes of blindness in the United States is age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Trachoma is mostly found in the African population, which commits about 85 % of all diagnosed cases. In some areas, about 60 % of children below age five have been found positive for trachoma.

5.

Which Ocular Infection Leads to Blindness?

Many of the ocular lesions are treatable, and any developed vision impairment may be reversed with surgery. Unfortunately, some infections can cause blindness that may even be permanent. Trachoma, infectious keratitis, endophthalmitis, and ocular sepsis can be reasons for infection-related blindness.

6.

Does Poor Hygiene Cause Trachoma?

Trachoma is caused by eye-seeking flies or close-personal contact. These flies thrive in untoward environments. The most common risk factors for trachoma infections are crowded households, unhygienic surroundings, poor waste management, and lack of access to clean water.

7.

What Is the SAFE Strategy Against Trachoma?

SAFE is an acronym that condenses the WHO (world health organization, 2020) guidelines for trachoma prevention and treatment.
  - S: Surgery- To correct in-turned eyelashes.
- A: Antibiotics- Azithromycin to treat active infections.
- F: Face cleanliness- To break the cycle of transmission.
- E: Environment- To maintain a clean environment and access clean water.

8.

Are Trachoma and Pink Eye the Same?

Trachoma is a chronic and serious variant of conjunctivitis (pink eye). Trachoma is caused by a specific bacterium, Chlamydia trachomatis where as conjunctivitis is an acute bacterial infection caused by a range of different bacteria, including Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Moraxella lacunata, Streptococcus viridans, and Proteus mirabilis.

9.

What Is the Route of Getting Trachoma?

The causative organism, C. trachomatis, is an obligate intracellular bacterium and is transmitted from person to person by direct or indirect contact. Close physical contacts form the direct kind of contact. At the same time, eye-seeking flies are the vectors that indirectly transmits the bacterium among individuals, especially in crowded households.

10.

When Did Trachoma Originate?

The oldest mentioned history of trachoma dates back to 2600 B.C. from China which frequently mentioned the occurrence of the disease. The history was recorded in Ebers papyrus, which is essentially a set of medical prescriptions during 1500 B.C. Egypt.

11.

What Is the Vaccine Against Trachoma?

Unfortunately, despite countless innovations in the medical field and the persistence of the disease for over 5000 years, there is no vaccine available to the public. Although, an experimental vaccine is under development that has shown positive results in preventing trachoma infections in monkeys.

12.

Which Is the Animal Vector of Trachoma?

Trachoma is highly infectious, especially in a crowded household, and can spread through direct physical contact. Yet, eye-seeking flies, specifically Musca sorbens Wiedemann, have been reported to frequently act as the intermediate vector in spreading trachoma infections.

13.

Is It Possible for Contact Lenses to Cause Blindness?

Although rare, contact lens puts the wearer at risk for ulcers and ocular infections. The infection worsens rapidly and is usually resultant of improper care and usage of reusable contacts. According to reports, up to 1 in 500 contact lens users suffer from serious infections that can lead to blindness.
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Dr. Manjunath Natarajan
Dr. Manjunath Natarajan

Ophthalmology (Eye Care)

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eye infectionconjunctivitiseyelid swellingtrachomachlamydia
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