Trachoma

Trachoma (Ancient Greek: "rough eye") is an infectious eye disease, and the leadingcause of the world's infectious blindness.

Trachoma is caused by the bacterium Chlamydia trachomatis and it is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with fomites (inanimate objects), such as towels and/or washcloths, that have had similar contact with these secretions. Untreated, repeated trachoma infections result in a painful form of permanent blindness when the eyelids turn inward, causing the eyelashes to scratch the cornea. Children are the most susceptible to infection, but the blinding effects are often not felt until adulthood.
Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors are indirectly linked to the presence of trachoma including lack of water, absence of latrines or toilets, poverty in general, flies, close proximity to cattle, crowding and so forth.

Prevention
Although trachoma was eliminated from much of the developed world in the last century, this disease persists in many parts of the developing world particularly in communities without adequate access to water and sanitation. In many of these communities, women are three times more likely than men to be blinded by the disease.
Without intervention, trachoma keeps families shackled within a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.
National governments in collaboration with numerous non-profit organizations implement trachoma control programs using the WHO-recommended SAFE strategy, which includes:
Surgery to correct advanced stages of the disease;
Antibiotics to treat active infection, using Zithromax donated by Pfizer Inc through the International Trachoma Initiative;
Facial cleanliness to reduce disease transmission;
Environmental change to increase access to clean water and improved sanitation.
Surgery: For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the lashes away from the globe.Early intervention is beneficial as the rate of recurrence is higher in more advanced disease.

Antibiotic therapy: WHO Guidelines recommend that a region should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one to nine year-old children is greater than 10 percent. Subsequent annual treatment should be administered for three years, at which time the prevalence should be reassessed. Annual treatment should continue until the prevalence drops below five percent. At lower prevalences, antibiotic treatment should be family-based. Antibiotic selection: WHO recommends azithromycin (single oral dose of 20mg/kg) or topical tetracycline (one percent eye ointment twice a day for six weeks). Azithrtomycin is preferred because it is used as a single oral dose. InitiativeAzithromycin can be used in children from the age of six months and in pregnancy.
Facial cleanliness: Children with grossly visible nasal discharge, ocular discharge, or flies on their faces are at least twice as likely to have active trachoma as children with clean faces Intensive community-based health education programs to promote face-washing can significantly reduce the prevalence of active trachoma, especially intense trachoma (TI).

Environmental improvement: Modifications in water use, fly control, latrine use, health education and proximity to domesticated animals have all been proposed to reduce transmission of C. trachomatis. These changes pose numerous challenges for implementation. It seems likely that these environmental changes ultimately impact on the transmission of ocular infection by means of lack of facial cleanliness. Particular attention is required for environmental factors that limit clean faces.

Symptoms
The bacteria has an incubation period of 5 to 12 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye." Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation will gradually subside.
The World Health Organization recommends a simplified grading system for trachoma.

The Simplified WHO Grading System is summarized below:
• Trachomatous inflammation, follicular (TF) – Five or more follicles of >0.5mm on the upper tarsal conjunctiva
• Trachomatous inflammation, intense (TI) – Papillary hypertrophy and inflammatory thickening of the upper tarsal conjunctiva obscuring more than half the deep tarsal vessels
• Trachomatous trichiasis (TT) – At least one ingrown eyelash touching the globe, or evidence of epilation (eyelash removal)
• Corneal opacity (CO) – Corneal opacity blurring part of the pupil margin
Further symptoms include:
Eye discharge
Swollen eyelids
Trichiasis (turned-in eyelashes)
Swelling of lymph nodes in front of the ears
Corneal scarring
Further ear, nose and throat complications.

Prognosis
If not treated properly with oral antibiotics, the symptoms may escalate and cause blindness, which is the result of ulceration and consequent scarring of the cornea. Surgery may also be necessary to fix eyelid deformities.