Trachoma

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Trachoma
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Acknowledgement

• Materials from the WHO programme for prevention
  of blindness is used for this presentation

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Introduction

• Ocular infection with clamidia trachomatis
  serovars A,B,Ba and C
• Second leading cause of blindness worldwide
• Disappearance in Europe and America predated
  antibiotics

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Pathogenesis of trachoma blindness

• Normal conjunctiva
• Trachoma conjunctivitis and re-infection
• Secondary bacterial infections
• Scarring
• Trichiasis
• Corneal opacity
• Blindness

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Magnitude of the problem

• 590 million people at risk from blinding trachoma
• 150 million people have active trachoma
• 10.6 million people have trichiasis
• 5.9 million people blind from trachoma
• 15 of global blindness 2nd cause of blindness

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Geographic distribution of blinding trachoma
(Thylefors, 1995)
Region Number with blinding trachoma
India 865,000
China 1,174,000
Other Asia and Islands 1,362,000
Sub-saharan Africa 1,380,000
Latin America 158,000
Middle-East 927,000
Total 5,866,000
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Distribution of disease

• Trachoma is concentrated in hot, dusty, dry parts
  of the world. Proxy for poverty
• Within endemic countries, trachoma is found in
  areas that are
• Rural
• Economically underdeveloped
• Without good water supplies
• Without basic sanitation
• Since it is an infectious disease, trachoma
  clusters at neighbourhood and household level

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Intervention SAFE strategy

• Surgery for trichiasis
• Antibiotics for TF/TI
• Facial cleanliness to prevent transmission
• of C. trachomatis
• Environmental change to prevent
• transmission of C. trachomatis

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Transmission of Infection

• Transmission of chlamydia from ocular and nasal
  secretion of children
• Direct spread during play/sharing a bed
• Conveyance on fingers
• Indirect spread on fomites
• Eye-seeking flies
• Coughing/sneezing

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Disruption of Infection cycle

• Antibiotics
• Faces, Fingers, Fomites and Flies Hygiene
• Environmental changes
• water provision and use
• Overcrowded housing
• Domestic waste management
• Animal proximity to household

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Which antibiotic?
Tetracycline ointment b.d. for 6 weeks Cures
60-80 of cases of TF/TI if full course is
administered compliance a problem
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Which antibiotic?
Oral azithromycin More effective than
tetracycline in normal programme conditions
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Role of Optometrists

• Training
• Education
• Community diagnosis
• Refraction/correction
• Low vision aids