Trachoma : Detailed Causes,Symptoms,Medications and Surgery

Trachoma

Short Answer Trachoma is a kind of bacterial infection that affects the eyes.

Detailed Answer Trachoma is an infectious disease of the eye because of an obligate intracellular bacterium referred to as Chlamydia trachomatis (Chlamydia is a Parasitic Bacteria like a virus). This bacterial infection causes a roughening of the inner floor of the eyelids. This roughening similarly can lead to pain in eyes and results in the breakdown of the cornea of eyes or affecting the conjunctiva(pink eye).

This repeated infection if left untreated can also result in everlasting trachoma blindness making the eyelids turn inwards. So, the trachoma blindness or visual impairment because of trachoma is said to be irreversible. Trachoma is likewise called granular conjunctivitis or blinding trachoma.

Background Trachoma is liable for actively spreading blindness or visual impairment across the globe. Likewise, around 1.9 million humans from 44  different countries are laid low with blindness or visual impairment because of trachoma. 

In step with the information amassed via WHO in March In 2019, approximately 142 million human beings are residing in trachoma endemic areas and are on the verge of trachoma blindness. In trachoma active regions, the chances of having this infection among preschool children are as high as 60-90%. This infection is determined to be much less frequent and shorter in length amongst people of increasing age.


Trachoma Eye

Trachoma Eye , Trachoma Treatment , Causes of Trachoma , Signs of Trachoma
Trachoma Eye


Causes of Trachoma
This eye ailment called trachoma is a result of Chlamydia trachomatis, a bacterium that could bring about sexually transmitted infection Chlamydia. Trachoma is a transmissible disease with the extensive essence of the distribution. In trachoma, handover of the activator is attainable –
  • By direct contact with eye, nostrils, throat secretions from the affected individuals.
  • By means of direct touch with objects or materials which may also bring infection such as towels, utensils, and furniture (that have similar contact with the secretions of the affected individual).
  • By mechanical transfer which incorporates insects (flies).
The possibility of blinding trachoma increases with untreated repeated infection because it will badly have an effect on the conjunctiva or cornea of eyes.

Prone factors for Trachoma
According to WHO, trachoma is prevalent in lots of poorest and primarily  rural regions of Africa and other developing nations. Trachoma is hyperendemic in regions having the least standard of living. Any person’s immune system can clear a single episode of infection but in endemic areas where trachoma is long-standing its prevention for repeated infection is not easy. So, the environmental factors which are greater inclined in spreading the infection of trachoma includes-
  • Poverty.
  • Crowded living areas.
  • Poor maintenance of hygiene and sanitation facilities.
  • Shortage of latrines ( or use of more communal latrines ).
  • Shortage of water.

Additionally, it is seen that kids of smaller age are liable to this infection instead of individuals of greater age. However, this infection easily gets a switch to women from a child due to close contact than men. So, this particularly increases the danger of repeated infection amongst the child.

Signs and symptoms of Trachoma
The signs and symptoms of this bacterial infection mainly influences both the eyes which include-
  • Moderate itching and irritation in eyelids or eyes.
  • Discharge from eyes ( containing pus or mucus ).
  • Eyelid roughening might also cause swelling of the eyelid.
  • Eye may also get sensitive to light.
  • Excessive eye pain and blurry vision.


Classification of Trachoma
The WHO has simplified grading method for trachoma which incorporates five tiers as follows-
  • Trachomatous inflammation- follicular (TF)- This is the primary level where the infection just start. In this stage, 5 or more follicles of size > 0.5 mm seem on the internal floor of the conjunctiva ( Follicles are small bumps which contain white blood cells ).
  • Trachomatous inflammation- intense (TI)- On this stage, the eye gets highly infected and irritated which can also bring about swelling up of upper eyelid (conjunctiva ).
  • Trachomatous scarring (TS)- As the infection progresses or gets repeated with this stage, scarring of the inner layer of the eyelid can also occur. This will further result in a  medical condition called Entropion, where the eyelid turns inward.
  • Trachomatous trichiasis (TT)- As the scarring of the inner layer of eyelid continues to disfigure resulting in entropion, the eyelashes begin to grow inward towards the eye. This condition referred to as trichiasis of eye. Eyes get more irritated as those eyelashes get to rub in opposition to the cornea, conjunctiva, and the inner floor of eyelids.
  • Corneal opacity (CO)- This is the very last stage wherein the cornea will become cloudy or scarred if trichiasis left untreated. This, in the end, ends in the ailment of the cornea known as corneal opacity.

All the above mention tiers of trachoma appear more severe in upper eyelid than in lower eyelid. Additionally, with more progress in infection, several other glands like tear generating gland may get affected which might be more favorable to worse the condition of the eye to intense dryness.

Prevention of Trachoma
An individual is capable to recover from a single wave of this bacterial infection. But the problem or concern with this bacterial infection is re-infection. That’s why this contagious disease is spreadable worldwide. So, a series of proper hygiene steps may be adopted to prevent trachoma consists of-
  • Proper handwash and facewash practice.
  • Insects like flies may be abolished by preserving proper sanitation practices.
  • Proper disposal of waste to ensure elimination of flies.
  • Accessibility  to pure and clean water.

All the above-stated hygiene practices are some of the important conditions for maintaining a standard of living. The WHO also promoted a method to prevent trachoma, named as SAFE which incorporates-
  • The surgical procedure to treat the eye condition called trachomatous trichiasis.
  • Antibiotics are provided to clear or to lessen this bacterial eye infection.
  • Facial cleanliness is promoted.
  • Environmental enhancement, with the aid of proper sanitation and access to water.


Trachoma Treatment
This includes - medications and surgery depending on the stage of trachoma.
For medications-
  • Antibiotics are used to treat early-stage trachoma.  The aim of using antibiotics is to reduce or kill the growth of trachomatis bacteria. The antibiotic used for the treatment of trachoma is azithromycin.

Generally, the dose of this antibiotic for children  is 20mg/kg in a single dose and  in  case of adults the amount varied to 1 g in a single dose.
  • For some cases of trachoma, a tetracycline eye ointment is prescribed which is applied to both eyes twice a day for 6 weeks.

But it is studied that azithromycin is more effective in treating trachoma than tetracycline and hence more costly.
For Surgery- It is recommended by the doctor as well as by WHO guidelines in later stages of trachoma.
  • Eyelid rotation surgery (bilamellar tarsal surgery)- in which eyelashes are rotated away from the cornea of eyes and this, in turn, limit the progress of corneal scarring and further prevent the loss of vision.
  • Corneal transplantation needs to be done in some cases to stop impairment of eye vision where the cornea becomes scarred or cloudy fully. However, this method of surgery does not have good results.
  • Another option is to remove the eyelashes in some cases in order to keep them separated from the cornea of eyes. But this procedure needs to be done repeatedly.


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