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Everything You Need To Know About Trachoma

Trachoma is the leading cause of infectious blindness in the world today. In areas where trachoma is endemic, active trachoma is common among preschool-aged children, with prevalence rates as high as 60–90%. The infection becomes less frequent and shorter in duration with increasing age. Typically, the infection is acquired when living near others with active disease, and the family is the primary setting for transmission.

The immune system can clear a single episode of infection, but in endemic communities’ re-acquisition of the organism occurs frequently. The disease causes blindness in women 1.8 times more than in men worldwide.

What is Trachoma?

Trachoma is an infectious eye disease arising from a bacterium Chlamydia trachomatis infection. It belongs to a class of ailments called neglected tropical diseases, or NTDs. Like conjunctivitis, trachoma first manifests as a treatable bacterial illness. If the infection is left untreated, eyelids become deformed, and the inverted eyelashes damage the eyeball surface by rubbing against it. It is an agonizing condition and is known as trichiasis. Recurrent peated infections can lead to irreversible blindness.

How is Trachoma Spread?

Trachoma is typically spread by:

  • Direct or indirect contact with infected person’s eye and nose discharges, especially when such individuals are young children, who are the main reservoirs of infection
  • Indirect contact; touching infected objects, such as contaminated clothing, towels, sheets, or blankets.
  • Exposure to contaminated flies

Chlamydial conjunctivitis typically goes away within a month or two with little to no lasting effects. A person may need approximately 150 episodes of reinfection to maintain the inflammation long enough to cause severe scarring that can lead to trichiasis, vision loss, and blindness.

Risk Factors of Trachoma

Trachoma is usually associated with poverty, and poor personal and community hygiene is the primary risk factor. Other risk factors include:

  • Crowded households
  • Young Age, as the infection is more prevalent in preschoolers
  • Subpar housing and a lack of functional bathrooms
  • Poor personal hygiene, particularly a filthy face
  • Inadequate access to and use of sanitation
  • Inadequate water access

Trachoma Symptoms

Five to twelve days after infection, signs and symptoms start to appear, and these may include:

  • Eyelid swelling
  • Abnormal development of corneal blood vessels
  • Conjunctivitis; ocular discomfort, redness, and discharge
  • Scarring of the cornea, the translucent membrane covering the surface of the eye
  • The development of eyelashes that turn into the upper lid and then brush against the cornea
  • Inflammation within the lymphoid follicles and lumps brought on by an immune system reaction
  • Scarring and deformation of the upper eyelid over time as a result of recurrent bouts of infection

Without a specialized search for it, trachoma may go unnoticed because some affected individuals are asymptomatic (without symptoms).

Global Distribution

Around the world, 157 million people reside in locations where they are at risk of contracting trachoma. About 1.9 million people have blindness or visual impairment because of it. Globally, it is responsible for 1.4% of all blindness cases. Many of the poorest and most rural regions of Central and South America, Australia, Asia, Africa, and the Middle East are hyperendemic for trachoma.

Economic Impact

Trachoma places a heavy financial strain on those who are afflicted as well as their communities. The annual economic cost of blindness and visual impairment in terms of lost production is estimated to be between US$ 2.9 and US$ 5.3 billion. It rises to US$ 8 billion after taking trichiasis into account.

Diagnosis of Trachoma

The identification of trachoma may involve the following tests:

  • A physical examination that includes an eye examination that includes lifting or flipping the eyelid
  • An eye sample for laboratory testing, although a clinical examination is typically required to make a diagnosis.
  • Medical history

Prevention and Trachoma Treatment

The primary preventative measures against trachoma are maintaining a clean face and environment. The WHO-recommended SAFE method is used to undertake elimination programs in endemic countries. This entails:

  • Improving facial hygiene to prevent infection from spreading to others and minimize reinfection
  • Environmental changes, including better water and sanitation systems for homes and communities.
  • The use of antibiotics to treat infections, particularly the widespread use of azithromycin, an antibiotic whose maker donates it to trachoma elimination efforts. In simple situations, the first line of treatment is one oral dose of azithromycin. This medication permits the body’s natural healing processes to restore the eye by getting rid of germs.
  • Surgery to treat trachomatous trichiasis, which is in the blinding stage. It is applied to older individuals to fix the malformation of the eyelids and turn outward the damaged eyelashes.

To meet elimination goals, most of the endemic nations have consented to quicken this strategy’s execution. Data for 2021 supplied to WHO by Member States show that 64.6 million people in endemic populations received antibiotic treatment to eradicate trachoma, and 69 266 people with trachomatous trichiasis received corrective surgery in that year.

The ability of programs to carry out community-based work was unaffected by COVID-19 in 2019, allowing 92 622 persons with trachomatous trichiasis to receive corrective surgery and 95.2 million people to receive antibiotic treatment. Elimination efforts must continue to achieve the goal of eliminating trachoma as a public health issue outlined in World Health Assembly resolution WHA 51.11.

The full participation of numerous parties involved in water, sanitation, and socioeconomic development will be particularly crucial.

Complications of Trachoma

Without medical intervention, persistent infections and inflammation can result in corneal scarring and inversion of the eyelids, which causes the eyelashes to rub against the eye with each blink. Trichiasis is an advanced form of trachoma, and the pain can be so severe that many people tear out their eyelashes to lessen the discomfort of blinking. Trichiasis might eventually result in vision loss and irreversible blindness if not addressed.

Visual impairment or blindness worsens the life experience of affected individuals and their families, who are already amongst the poorest of the poor. Women are blinded up to 4 times as often as men, probably due to their close contact with infected children and their resulting greater frequency of infection episodes.

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