What is trachoma?

Causes and Symptoms

Trachoma is caused by the
Chlamydia trachomatia bacteria. It is carried primarily by children throughout the developing world, where water is scarce and washing is difficult. Combined with a general lack of hygiene, blowing dust and smoke from cooking fires provide a perfect environment for Chlamydia trachomatia
bacteria to take hold.

Flies
from refuse areas crawl on faces of children who sleep in crowded conditions. The insects
touch those children with the bacteria, then infect and reinfect others rapidly throughout an entire village. The eyes
become red, painful, and sticky, causing irritation to the underside of the eyelid. Infection easily spreads as children touch the faces of their mothers and other children.

Left untreated, the eyelid and eyelashes turn in, damaging the cornea. The disease becomes more painful and injurious to adults as the eyelashes break off. This bristle-like effect lacerates the cornea and opaque scarring builds (a condition called trichiasis).
Blindness
is inevitable, usually by the age of forty to fifty.

Treatment and Therapy

Tetracycline eye ointment, twice a day for six weeks, gets rid of the infection. Face cleansing, especially for children, is the best way to prevent infection, along with environmental improvement and education. After the disease has advanced, the last hope is a surgical procedure to rotate the eyelid to its original position. The procedure is relatively simple. Nurses, medical assistants, and technicians can be trained to perform it at local clinics. Efforts to eliminate Musca sorbens, the aggressive flies in Africa and Asia, are also effective in controlling trachoma.

Perspective and Prospects

The World Health Organization (WHO) estimates trachoma has blinded 6 million of the 38 million blind people in the world. Active infectious trachoma affects 150 million children. Areas most affected are Mexico, Brazil, Burkina Faso, Egypt, Kenya, China, Myanmar, and interior Australia.

In 1997, WHO launched a concerted effort to control trachomatous blindness by forming a consortium, the Global Elimination of Trachoma by 2020 (GET 2020). Strategy for GET 2020 is summarized by the acronym “SAFE,” which refers to the four field-tested activities for control of trachoma; surgery, antibiotics (tetracycline), clean faces, and environmental change. Trachoma control is one of the most affordable health interventions.

Education of the peoples involved is difficult. Because the disease is not fatal, they have little concern, accepting the disease as a fact of life. Mothers are being educated to find time to retrieve well water for washing their children’s faces even when drought and poverty make feeding their families a trial. Mothers are being taught to understand the relationship between dirt on children’s faces and the eye diseases making their own eyes red and sore. As such environmental improvement techniques are taught, villages are motivated to cooperate with worldwide and local agencies in the interest of curing trachoma.

Bibliography:

Buettner, Helmut, ed. Mayo Clinic on Vision and Eye Health: Practical Answers on Glaucoma, Cataracts, Macular Degeneration, and Other Conditions. Rochester, Minn.: Mayo Foundation for Medical Education and Research, 2002.

Dawson, Chandler. “Flies and the Elimination of Blinding Trachoma.” The Lancet 353, no. 9162 (April 24, 1999): 1376.

Hertle, Richard, David B. Schaffer, and Jill A. Foster, eds. Pediatric Eye Disease: Color Atlas and Synopsis. New York: McGraw-Hill, 2002.

Johnson, Gordon J., et al., eds. The Epidemiology of Eye Disease. 2d ed. New York: Oxford University Press, 2003.

Mayo Clinic. "Trachoma." Mayo Clinic, October 3, 2012.

Miller, Stephen J. H. Parsons’ Diseases of the Eye. 19th ed. New York: Elsevier, 2002.

Schachterm, J., et al. “Azithromycin in Control of Trachoma.” The Lancet 354, no. 9179 (May, 1999): 630.

Sutton, Amy L., ed. Eye Care Sourcebook: Basic Consumer Health Information About Eye Care and Eye Disorders. 3d ed. Detroit, Mich.: Omnigraphics, 2008.

Vorvick, Linda J. "Trachoma." MedlinePlus, September 3, 2012.

World Health Organization. "Global Health Observatory: Trachoma." World Health Organization, 2013.