Trachoma is a bacterial infection affecting the eyes, caused by Chlamydia trachomatis. It is the foremost infectious cause of preventable blindness globally, disproportionately impacting communities with limited resources and poor hygiene. The disease progresses through repeated infections, leading to severe eye damage if not addressed.
Understanding Trachoma
Trachoma is caused by certain serovars of Chlamydia trachomatis, primarily A, B, Ba, and C. This bacterium infects the conjunctiva, the membrane lining the inside of the eyelids and covering the white part of the eyeball. The infection initiates an inflammatory response in this tissue.
The spread of trachoma occurs through direct contact with eye and nose discharge from an infected individual, via hands or contaminated clothing. Indirect transmission is often facilitated by flies, particularly Musca sorbens, which transfer infected discharge to others’ eyes. Transmission intensifies in environments with inadequate sanitation, limited access to clean water, and crowded living conditions, allowing the bacterium to circulate easily.
Recognizing the Signs
The World Health Organization (WHO) outlines progressive stages of trachoma. The initial phase, active trachoma, includes follicular trachoma (TF) and intense trachoma (TI), marked by conjunctival inflammation. In TF, small, raised bumps called follicles appear on the inner surface of the upper eyelid, indicating active infection.
The disease can advance to chronic stages. Trachomatous scarring (TS) develops when the inflamed conjunctiva forms fibrous bands and scar tissue on the inner eyelid. This scarring can lead to trachomatous trichiasis (TT), a painful condition where the eyelid turns inward, causing eyelashes to rub against the cornea, the clear front part of the eye. Continuous abrasion from misdirected eyelashes eventually results in corneal opacity (CO), where the cornea becomes cloudy, leading to irreversible vision loss and blindness.
Treatment Approaches
Treating trachoma involves a two-pronged approach: eliminating active infection and correcting damage from advanced stages. For active bacterial infection, antibiotics are the primary intervention. Oral azithromycin is widely used, often administered through mass drug administration campaigns in prevalent communities.
Topical tetracycline eye ointment is also used for active cases. For individuals with trachomatous trichiasis (TT), surgical intervention is necessary to prevent further corneal damage and preserve remaining vision. Procedures like bilamellar tarsal rotation correct the inward-turning eyelid, redirecting eyelashes away from the eye’s surface. This surgical correction alleviates pain and prevents progression to irreversible blindness.
Prevention and Global Eradication Efforts
Global efforts to control and eliminate trachoma are guided by the World Health Organization’s (WHO) SAFE strategy. This comprehensive approach encompasses four main components: Surgery for trichiasis, Antibiotics for active infection, Facial cleanliness, and Environmental improvements. Each element contributes to breaking the cycle of infection and preventing disease progression.
Facial cleanliness, particularly among children, is promoted through regular face washing with soap and water, which reduces bacterial load and minimizes the attraction of flies that spread infection. Environmental improvements involve enhancing access to safe water and improving sanitation facilities, such as latrines, to reduce bacterial presence. Fly control measures also limit transmission. Trachoma is classified as a neglected tropical disease, and global partnerships work towards its elimination through sustained SAFE strategy implementation, aiming to ensure no one loses sight to this preventable condition.