Trachoma: The Invisible Threat to Vision

What is Trachoma?

Trachoma is a contagious bacterial infection of the eye caused by the bacterium Chlamydia trachomatis. It is the leading infectious cause of blindness worldwide, predominantly affecting impoverished communities with limited access to clean water and adequate sanitation.

Transmission

Trachoma spreads through direct or indirect contact with the discharge from the eyes or nose of an infected person. Common modes of transmission include:

• Touching the eyes after coming into contact with contaminated fingers or objects.
• Shared use of towels or face cloths.
• Flies that have been in contact with the discharge from infected eyes can also transfer the bacteria.

Symptoms

Trachoma typically progresses through five stages, each with distinct symptoms:

1. Inflammation – Follicular: The initial stage is characterized by the presence of five or more follicles on the inner surface of the upper eyelid.
2. Inflammation – Intense: The eye becomes severely inflamed and irritated, with thickening and swelling of the upper eyelid.
3. Eyelid Scarring: Repeated infections lead to scarring of the inner eyelid, which appears as white lines.
4. Trichiasis: Scarred tissue causes the eyelashes to turn inward and scratch the cornea, leading to pain and further infection.
5. Corneal Opacity: Continued scratching and infection result in corneal ulcers and scarring, ultimately causing blindness if untreated.

Populations at Risk

Trachoma predominantly affects children and women in rural, impoverished areas where water and sanitation are insufficient. Key risk factors include:

• Living in crowded conditions.
• Lack of access to clean water and sanitation.
• Poor hygiene practices.
• Proximity to livestock and flies.

Diagnosis

Healthcare providers diagnose trachoma through clinical examination of the eyes, specifically looking for follicles, inflammation, and scarring. In some cases, laboratory tests confirm the presence of Chlamydia trachomatis.

Treatment and Prevention

Early treatment of trachoma is crucial to prevent irreversible blindness. The World Health Organization (WHO) recommends the SAFE strategy for trachoma control:

1. Surgery (S): To correct advanced trachoma (trichiasis) and prevent blindness.
2. Antibiotics (A): Distribution of antibiotics like azithromycin to eliminate the infection.
3. Facial cleanliness (F): Promoting face washing to reduce transmission.
4. Environmental improvement (E): Improving access to clean water and sanitation to reduce spread.

Preventative measures also include:

• Ensuring proper hand and face hygiene.
• Reducing fly populations through waste management and environmental changes.
• Educating communities about the importance of hygiene and sanitation in preventing infection.

Challenges and Global Efforts

Despite significant progress, trachoma persists in many parts of Africa, Asia, Latin America, the Middle East, and Australia. Global health organizations continue to work towards elimination through mass drug administration and improved hygiene practices. The WHO aims to eliminate trachoma as a public health problem by 2030 through coordinated international efforts.