It is a bacterial infection in the whites of the eye that can cause blindness.
It presents as chronic inflammation of the conjunctiva, the outer tissue that lines the eyelid and the white of the eye.
Trachoma is the leading cause of infectious blindness in the world today.
Up to 8 million people are permanently blind due to Trachoma, and another 84 million need treatment to prevent blindness.
The inflammation caused by trachoma infection results in the conjunctiva scarring and becoming rough, which interferes with the eye’s function to lubricate itself to protect the clear front tissue of the eye, the cornea.
As the disease continues, the cornea heals.
The abnormal blood vessels begin to grow inward, causing reduced vision and, in some cases, blindness.
In the very advanced stages of the condition, the eyelid can become so scarred that it turns inward, forcing the eyelashes to rub against the cornea.
This is extremely painful and damaging.
Causes of Trachoma
Trachoma is caused by a particular strain of the Chlamydia Trachomatis bacteria.
A different strain of the same bacteria causes the venereal disease called chlamydia.
It is important to note that Trachoma is not a sexually transmitted disease.
Trachoma is more common in impoverished and developing communities.
It is caused by poor living conditions, such as poor sanitation, shared towels, inadequate personal and community hygiene, and a lack of cleanliness education (primarily related to face washing).
Inadequate housing areas, with human overcrowding, poor supply of clean water, and presence of animals and insects such as flies that have contact with human or animal feces.
Anyone who comes into contact with an infected person may also be at risk of contracting the infection.
Since Trachoma is a disease easily transmitted from one infected person to another.
Direct contact, such as touching infected discharge from the eye, nose, or mouth, or indirect contact, such as touching infected objects.
Flies and insects can carry these secretions from one person to another. It is commonly seen in crowded and endemic areas.
Children between the ages of 3 to 5 years are prone to contract this eye infection through their siblings, parents, and playmates.
It occurs after multiple episodes of eye infection.
Trachoma has been eliminated from the majority of the population in the developed world. However, it is still endemic in areas with poor hygiene, poor water supplies, and where people live in crowded conditions.
It is especially prevalent in remote rural areas in Africa, Asia, and South America, and among Aboriginal groups in Australia.
Approximately 84 million people are currently infected with Trachoma, of which about 10% are visually impaired.
It is the most common infectious cause of blindness worldwide.
Several stages can co-occur:
Stage I: trachomatous inflammation
There is the follicular presence of five or more follicles in the superior tarsal conjunctiva.
The follicles are whitish, gray, or yellow elevations, paler than the surrounding conjunctiva.
Stage II: severe trachomatous inflammation
The superior tarsal conjunctiva is red, rough, and thickened.
Usually, visible blood vessels are masked by diffuse inflammatory infiltration or follicles.
Stage III: trachomatous scarring
The follicles disappear, leaving scars; the scars are white lines, bands, or patches on the tarsal conjunctiva.
Stage IV: trachomatous trichiasis
Due to multiple scars, the eyelid margin turns inward (entropion), and the eyelashes rub against the cornea, causing ulcerations and chronic inflammation.
Stage V: corneal opacity
The cornea gradually loses its transparency, leading to visual impairment and blindness.
The first two stages are “active stages,” The bacterial infection triggers the release of cytokines into the conjunctiva (the transparent membrane that lines the eye and eyelid) and causes swelling of the eyelid tissue.
The later stages result from chronic inflammation and can lead to entropion (the formation of scar tissue that causes the eyelid to turn inward), with the lashes scratching and irreversibly damaging the corneal surface.
Children show the active stages of infection more frequently, while older people, who have suffered repeated reinfections, have marked conjunctival scars and visual impairment.
The absence of active bacterial infection in the later stages of the disease has implications for treating Trachoma; However, antibiotics can kill the C. trachomatis bacteria, and antibiotic treatment does not cure irreversible eye damage caused by years of repeated infections.
Among the most common symptoms of Trachoma are:
- Sensitivity to bright light.
- Swollen eyelids
- Watery discharge from the eyes.
- Formation of white lumps under the surface of the upper eyelids.
- Misdirected eyelashes are called Trichiasis.
- Inflammation in the eyes.
- Redness of the inner eyelids.
- Distortion in the eyelids.
- Swollen lymph nodes.
- Ear, nose, and throat complications with worsening of the situation.
A significant complication of Trachoma includes corneal ulcers due to friction from concentrations with bacterial infections.
Diagnosis of trachoma
Trachoma may not initially show any severe symptoms, but there are many bacteriological tests available for the clinical diagnosis of Trachoma.
The eyes and eyelids are examined to diagnose Trachoma.
Apart from this, the patient’s history and living conditions are reviewed to conclude.
The eye exam is done through a biomicroscope that helps see changes in the eyes and eyelids.
Symptoms related to irritability of the conjunctiva and cornea can also be seen through an eye exam.
Diagnosis in the field is generally made based on clinical presentation in endemic areas, and therefore treatment is often presumptive.
An investigator-developed rapid dipstick immunoassay test is very effective in diagnosing Trachoma.
The clinical diagnosis of late-stage visual impairment caused by Trachoma allows doctors to recommend surgery or some physical intervention to prevent further damage to the cornea.
The definitive diagnosis of active infection is made in the laboratory using enzyme immunoassays, serology, or identification of the C. trachomatis bacteria with the microscopic evaluation of the conjunctival tissue.
Treatment will depend on the stage of the disease.
Etapas I y II
Cleanse the eyes and face several times a day.
Antibiotics would help in an early stage.
It can help reduce inflammation caused by infection.
It can also help stop watery discharge from the eyes, and eventually, the infection will subside after proper antibiotic therapy.
While no medications target C. trachomatis infection, azithromycin and tetracycline are the antibiotics of choice.
Oral formulations of the drugs are often given in large quantities, while topical ointments or eye drops are used to treat existing infections.
Antibiotic therapy is a treatment of choice.
In children under six months or 6 kg: erythromycin is recommended orally, at a dose of 20 mg per kg of body weight twice a day for 14 days.
In children older than six months or older than 6 kg of body weight, a single dose of 20 mg per kg of azithromycin orally is recommended.
In adults, a single dose of 1 g is recommended.
In some cases, an eye ointment with 1% tetracycline is recommended, applied two times a day for six weeks.
- Stage III: no treatment.
- Stage IV: surgical treatment.
While awaiting surgery, if possible, patients should be followed up regularly. Attaching the eyelashes to the eyelid is a palliative measure that can help protect the cornea.
In some instances, this can lead to permanent correction of the Trichiasis within a few months.
The method consists of gluing the eyelashes to the outer eyelid with a thin strip of adhesive plaster, ensuring that the eyelid can be opened and closed perfectly.
Replace the cast when it starts to come off (usually once a week) and continue treatment for three months.
Waxing growing lashes is not recommended as it only offers temporary relief, and regrowing lashes are more abrasive to the cornea.
People suffering from Trachoma or Trichiasis can get relief through surgery, namely bilaminar tarsal rotation that redirects the eyelashes.
Stage V: no treatment
Facial cleansing is essential, especially for children in the 3-9 age group.