Trachoma is a contagious bacterial infection which affects the conjunctival covering of the eye, the cornea, and the eyelids. It is the world’s leading cause of preventable blindness of infectious origin.
The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness.
It is caused by the bacterium Chlamydia trachomatis and spreads through contact with the eyes, eyelids, and nose or throat secretions of infected people. It can also be passed on by handling infected items, such as shared towels, cloths, handkerchiefs, and flies that have come in contact with the eyes or nose of an infected person.
Trachoma transmission occurs primarily between children and the women who care for them.
Globally, almost 8 million people are visually impaired by trachoma; 500 million are at risk of blindness from the disease throughout 57 endemic countries.
Signs and symptoms of trachoma usually affect both eyes and may include:
Mild itching and irritation of the eyes and eyelids
Discharge from the eyes containing mucus or pus
Swelling of lymph nodes in front of the ears
Sensitivity to bright lights (photophobia)
Increased heart rate
Further ear, nose and throat complications.
Young children are particularly susceptible to infection. But the disease progresses slowly, and the more painful symptoms may not emerge until adulthood.
Untreated trachoma can lead to blindness. Early treatment may help prevent trachoma complications.
The World Health Organization has identified five stages in the development of trachoma:
All the signs of trachoma are more severe in your upper lid than in your lower lid. With advanced scarring, your upper lid may show a thick line.
In addition, the lubricating glandular tissue in your lids (including the tear-producing glands [lacrimal glands]) can be affected. This can lead to extreme dryness, aggravating the problem even more.
When to see a doctor
Call your doctor if you or your child has itchy or irritated eyes or discharge from the eyes, especially if you live in or recently travelled to an area where trachoma is common. Trachoma is a contagious condition. Treating it as soon as possible helps prevent further infections.
Factors that increase your risk of contracting trachoma include:
Poverty. Trachoma is primarily a disease of extremely poor populations in developing countries.
Crowded living conditions. People living in close contact are at greater risk of spreading infection.
Poor sanitation. Poor sanitary conditions and lack of hygiene, such as unclean faces or hands, help spread the disease.
Age. In areas where the disease is active, it's most common in children ages 4 to 6.
Sex. In some areas, women's rate of contracting the disease is two to six times higher than that of men.
Flies. People living in areas with problems controlling the fly population may be more susceptible to infection.
Lack of latrines. Populations without access to working latrines (a type of communal toilet) have a higher incidence of the disease.
Your doctor can diagnose trachoma through a physical examination or by sending a sample of bacteria from your eyes to a laboratory for testing. But lab tests aren't always available in places where trachoma is common.
Treatment for Trachoma
The treatment is a single oral dose of antibiotic which is the preferred treatment, plus making safe water available and teaching simple cleanliness. Because of cultural differences and widespread poverty in endemic areas, this regimen is difficult to implement on a universal scale.
The World Health Organization (WHO) has developed a strategy to combat trachoma, with the goal of eliminating it by 2020. The strategy, titled SAFE, involves:
Surgery to treat advanced forms of trachoma
Antibiotics to treat and prevent the infection
Environmental improvements, particularly in water, sanitation and fly control
Treatment involves screening communities for the presence of trachoma in children 1-9 years of age. When over 10 % are found to have clinical disease, the entire community is treated with antibiotics. In areas with less disease, only targeted groups are treated.
Due to the contagiousness of trachoma, it is necessary to treat all who might be in contact with the infected individuals.
When trachoma has progressed to inward-turning of the lashes, surgery is necessary to correct this and prevent the lashes from scarring the cornea. Performance of this surgery can be taught to nurses or other medical personnel.
If significant corneal scarring already exists, corneal transplantation surgery may be required, which should be performed by an ophthalmologist.
Complications and Prognosis for Trachoma
One episode of trachoma caused by Chlamydia trachomatis is easily treated with early detection and use of antibiotics. Repeated or secondary infections can lead to complications, including:
Scarring of the inner eyelid
Eyelid deformities, such as an inward folding eyelid (entropion) or ingrown eyelashes (trichiasis)
Corneal scarring or cloudiness
Partial or complete vision loss
If diagnosed early, before scarring of the cornea, the prognosis is excellent. If not treated properly with oral antibiotics, the symptoms may escalate and cause blindness, which is the result of ulceration and consequent scarring of the cornea. Surgery may also be necessary to fix eyelid deformities.
Without intervention, trachoma keeps families shackled within a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.
If you've been treated for trachoma with antibiotics or surgery, re-infection is always a concern. For your protection and for the safety of others, be sure that family members or others you live with are screened and, if necessary, treated for trachoma.
Trachoma can occur worldwide but is more common in the Middle East, North Africa, sub-Saharan Africa, and areas of southern Asia and China. When in regions where trachoma is common, take extra care in practicing good hygiene, which can help prevent infection.
No trachoma vaccine is available, but prevention is possible.
Proper hygiene practices include:
Face washing and hand-washing. Keeping faces clean may help break the cycle of re-infection.
Controlling flies. Reducing fly populations can help eliminate a major source of transmission.
Proper waste management. Properly disposing of animal and human waste can reduce breeding grounds for flies.
Improved access to water. Having a fresh water source nearby can help improve hygienic conditions.
What research is being done on trachoma?
Since the cause is well understood and treatment is effective, research is concentrating on methodology to deliver the treatment efficiently to endemic areas of the world.
There is an International Trachoma Initiative (ITI) dedicated to eliminating trachoma by following the World Health Organization (WHO) SAFE strategy. It is partnering with governmental and private organizations, such as the Bill & Melinda Gates Foundation. If successful, trachoma may become a disease of the past in two generations; 15 countries are targeted for elimination of trachoma by 2020.