Trachoma, also known as Egyptian opthalmia or granular conjunctivitis is a disease which is caused by bacterial infection. The disease is caused by Chlamydia Trachomatis, which is an obligate intracellular bacterium. The infection leads to ocular morbidity in the patients and is also the cause of blindness. Trachoma belongs to the group of neglected tropical diseases, because it is more prevalent among low income individuals and their families in the developing nations such as Asia and Africa. A study estimates that more than forty million people are infected (active) all over the world, and eight million people suffer from visual damages due to this disease.
Symptoms of Trachoma
The incubation period of the bacteria is around five to twelve days; infected individuals experience the symptoms and signs of conjunctivitis disease. They will have irritation and ‘pink-eye’ as a result of the infection. The infection leads to the thickening of the inner walls of the eye lids and intense inflammation of the eye. Continuous infection of the eye causes a condition known as blinding endemic trachoma which causes the conjunctiva to be swollen or inflamed. The inflammation subsides gradually if there is no reinfection.
Active Trachoma is a condition which is caused by the inflammation of the conjunctiva commonly found in children of a younger age (preschool children). White lumps are formed in the lymphoid germinal centers or in the conjunctival follicles,which are regions found below the upper eye lids. It also causes thickening and inflammation which are usually non-specific and mostly associated with the papillae. Follicles also appear at the sclera, also known as the limbal follicles or at the confluence of the cornea. Patients with active trachoma will have constant water discharge and irritation in the eyes. Purulent discharge is caused due to the secondary infection caused by the bacteria.
Cicatricial Trachoma is the later stages of the active trachoma which is a result of the structural changes of the bacterium. Cicatricial Trachoma is characterized by the development of the tarsal conjunctiva or the scarring of the eyelids which leads to the distortion and bucking of the tarsus of the eyelid causing the eye lashes to rub against the outer surface of the eye, this condition is known as Trichiasis. Later, this leads to corneal opacities causing scarring of the eyelid which will eventually lead to blindness.
Children with active trachoma will have the following symptoms:
- Ocular Discharge
- Irritation
- Swollen eyelids
- Eye Pain
- Change of taste in mouth
- Difficultly in seeing things
- Swelling of the lymph nodes
- Turned-in eyelashes or Trichiasis
- Ear, nose and throat complications
- Sensitivity to light
- Increased heart rate
The first five symptoms are the initial stages of the disease and the later part are the symptoms of the advance stages. All the symptoms of the Trachoma mainly affect the upper eye lids than your lower eye lids. Trachoma causes extreme dryness and it also affects the lacrimal or the tear producing glands. Corneal Ulcer is caused by rubbing in a particular area; this may cause further infections or trichiasis.
Cause of Trachoma
Trachoma is a hygiene related disease which is caused by Chlamydia trachomatis and its sub types. The disease is easily spread by personal contact. Direct contact with the eye, throat and nose secretions of the infected individuals or contact by using the towels and clothes with these secretions will lead to the spreading of this infection. Trachoma is also transported by the flies which carries the infection from the affected individual. The disease is also found increasingly among women, who are more susceptible to this disease when compared to men. Mostly the transmission occurs at a lightning pace between the family members, poor hygiene conditions (crowded living, lack of proper sanitation, unavailability of water and poverty) is one of the main reasons for the wide spread of this disease in developing countries. Repeated infections and lack of proper treatment will lead to entropian – a condition which causes permanent blindness with intense pain where the eyelids of the affected individuals turn inwards.
Treatment
Physical examination by doctors followed by testing the samples taken from the eyes in the labs by culture test is how the disease is diagnosed. The treatment for Trachoma depends on the stage in which the disease is reported to the doctor.
- Drugs – The early stages of the disease can be arrested by oral administration of antibiotics to the patients. Zithromax (Oral Azithromycin) and Tetracycline eye ointment are the drugs which are prescribed to the patients with initial stages of the infection. Azithromycin is the most effective drug when compared with the eye ointment, but in poor countries drugs are prescribed based on the affordability and availability. The World Health Organization (WHO) recommends oral administration of antibiotics if more than 10 percentage of the community population is affected, this is done to eradicate the spreading of the disease and treat the individuals with symptoms.
- Surgery – Surgery is usually recommended for the advanced stages of Trachoma, the conditions include deformities in the eyelids also accompanied with intense pain. Eye lid rotation surgery is done as an outpatient procedure. An incision is made into the scarred tissue during the surgery; doctors rotate the eyelashes of the infected patient away from their cornea. The procedure helps to prevent the loss of vision and further advancements of the scarring of cornea. It also reduces the chances of repetitive infections. Corneal transplantation is done when there is an irrevocable damage to the vision of the patient, but the success rate if this surgery is very minimal. Epilation or removing the eyelashes will also be done for certain patients.
Prevention
When you are traveling to the areas which are prone to this infection, it is essential to follow good hygiene practices to avoid this disease. Washing of hands and face, proper waste management, improving the access to water and controlling the flies are some of the ways to prevent this infection.