Also mentioned in Corpus Hippocraticum by the father of methodical medicine, Hippocrates (5th century BC), Trachoma is a bacterial infection affecting the eye and possessing the potential to result in blindness.
Trachoma is said to have originated particularly in Egypt and Middle East and therefore it is also known as Egyptian Ophthalmia along with other alternative names like Granular Conjunctivitis, War Ophthalmia and Military Ophthalmia. Sometimes it is also generally referred as just Conjunctivitis.
As old as the history itself, Trachoma is prone to every race and community with even disastrous epidemic forms reported. Though, the number of cases has considerably reduced in most of the developed countries, it is not so in major part of developing nations as it is related to poverty and overcrowded conditions.
According to recent reports, trachoma has left nearly 8 million people blind whereas approximately 84 million need treatment. Compared to men, it is more common in children and women (especially in their 40s).
Causes of Trachoma
Trachoma is triggered due to the bacteria known as Chlamydia Trachomatis resulting in irritating eyes and discharge of mucous from the eyes at repeated times. Though it clears up in about a month’s time, it can spread rapidly due to poor hygiene. Other factors that spread the infection from person to person include direct eye contact, nose & throat secretions and using common objects like towel and washcloths.
At times, even insects (like flies) carry the discharge from infected person to a healthy human.
Symptoms of trachoma are usually noticed in 5-12 days after exposure to the bacteria starting with the eyelid lining tissue turning red/pink and swollen. Its symptoms are quite similar to ‘pink eye’. If untreated, it can even lead to developments of scars.
Itching and drainage of pus or mucus from the eye are among the first signs of trachoma. After a few days of disease progression, the patient turns sensitive to light or develops photophobia. Individuals also experience blurry vision and pain in the eye.
Some other trachoma symptoms include cloudy cornea, corneal scarring, swollen eyelids and turned-in eyelashes (a condition of trichiasis). Further complications related to ear, throat and nose are also observed.
The symptoms of trachoma in children include white lumps under the upper eye lid’s surface and appearance of follicles at the junction of sclera and cornea. The scars developed on the eyelid result in deformation of the lid such that the lashes rub against the eye. This rubbing gives way to more scars and corneal opacities which can lead to blindness.
The symptoms in children are usually not painful until the adulthood is reached as the disease progresses at a sluggishly.
An eye examination and laboratory tests are considered necessary to recognize the presence of Chlamydia trachomatis bacteria and thus diagnose the condition trachoma.
Once diagnosed, the various treatment options for trachoma depend on the stage and severity of the condition. For the initial stages, medications are used whereas a surgery becomes mandatory in the advanced stages.
There are no vaccines available for trachoma. However, an early detection treated with antibiotics like erythromycin and doxycycline as these have proved to be effective in the initial stages. These antibiotics work when experiencing symptoms like inflamed cornea and eyelids, light sensitivity and tearing. However, these antibiotics are not effective once the scars develop.
Some other medications for treating trachoma include tetracycline eye ointment and azithromycin (oral). Though, oral azithromycin is more effective, the price too is very high and therefore remains unaffordable to most not-so-rich communities.
When trachoma reaches the later stages an eyelid rotation surgery is required. Also known as bilamellar tarsal rotation surgery, it involves the rotation of eyelashes away from cornea by a small incision made in the scarred lid. This improves the eyesight by limiting the advancement of corneal scars. This simple surgery, lasting for hardly 15 minutes, has high enduring success rates.
If the cornea turns cloudy to the level that can result in blindness then corneal transplantation is needed. Corneal transplantation or Cornea grafting involves the replacement of infected corneas with healthy donor corneas. However, the success rate of corneal transplantation is reportedly low as the corneas can be rejected by the body.
The best way to avoid first time trachoma infection and re-infection is to maintain good sanitary conditions. Hygienic habits like regularly washing the face, reducing fly population, effective sanitation ways and cleaner water not only reduces the risk transmission of trachoma but also keeps it at bay forever.
Journal of Neuro-Ophthalmology by North American Neuro-Ophthalmology Society