trachoma

Trachoma 

Definition

Trachoma, which is also called granular conjunctivitis or Egyptian ophthalmia, is a contagious, chronic inflammation of the mucous membranes of the eyes, caused by Chlamydia trachomatis. It ischaracterized by swelling of the eyelids, sensitivity to light, and eventual scarring of the conjunctivae and corneas of the eyes.

Description

Trachoma is a major cause of blindness in the world. It is found in the Far East, as well as countries with desert climates. In the United States, it is most common among certain Native Americans and in parts of Appalachia. The infection is highly contagious in its early stages. Blindness results from recurrent untreated infections.

The conjunctiva is the clear mucous membrane that lines the inside of the eyelid and covers the white part (sclera) of the eye. Conjunctivitis is an inflammation of the conjunctiva.

Causes and symptoms

Trachoma is caused by C. trachomatis, a parasitic organism closely related to bacteria. It is transmitted by insects, by hand-to-eye contact, or by the sharing of infected handkerchiefs or towels. The incubation period is about a week.

The early symptoms of trachoma include the development of follicles (small sacs) on the conjunctivae of the upper eyelids, pain, swollen eyelids, a discharge, tearing, and sensitivity to light. If the infection is not treated, the follicles develop into large yellow or gray pimples, and small blood vessels develop inside the cornea. In most cases, both eyes are infected.

Repeated infections eventually lead to contraction and turning-in of the eyelids, scarring of the corneas and conjunctivae, eventual blockage of the tear ducts, and blindness.

Diagnosis

Diagnosis is based on a combination of the patient's history (especially living or traveling in areas with high rates of trachoma) and examination of the eyes. The doctor will look for the presence of follicles or scarring. He or she will take a small sample of cells from the patient's conjunctivae and examine them, following a procedure called Giemsa staining, to confirm the diagnosis.

Treatment

Treatment of early-stage trachoma consists of four to six weeks of antibiotic treatment with tetracycline, erythromycin, or sulfonamides. Antibiotics should be given without waiting for laboratory test results. Treatment may combine oral medication with antibiotic ointment applied directly to the eyes. A single-dose treatment with azithromycin is an alternative method. Tetracyclines should not be given to pregnant women or children below the age of seven years.

Patients with complications from untreated or repeated infections are treated surgically. Surgery can be used for corneal transplantation or to correct eyelid deformities.

Prognosis

The prognosis for full recovery is excellent if the patient is treated promptly. If the infection has progressed to the stage of follicle development, prevention of blindness depends on the severity of the follicles, the presence of additional bacterial infections, and the development of scarring.

Prevention

There are vaccines available that offer temporary protection against trachoma, but there is no permanent immunization. Prevention depends upon good hygiene and public health measures:

• seek treatment immediately if a child shows signs of eye infection, and minimize his or her contact with other children
• teach children to wash hands carefully before touching their eyes
• protect children from flies or gnats that settle around the eyes
• if someone has trachoma (or any eye infection), do not share towels, pillowcases, etc; Wash items well
• if medications are prescribed, follow the doctor's instructions carefully

Resources

Books

Riordan-Eva, Paul, et al. "Eye." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.

Key terms

Conjunctivitis — Inflammation of the conjunctivae, which are the mucous membranes covering the white part of the eyeball (sclera) and lining the inside of the eyelids.

Cornea — The transparent front part of the eye that allows light to enter.

Ophthalmia — Inflammation of the eye. Usually severe and affecting the conjunctiva. Trachoma is sometimes called Egyptian ophthalmia.

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trachoma /tra·cho·ma/ (trah-ko´mah) pl. tracho´mata   [Gr.] a contagious disease of the conjunctiva and cornea, producing photophobia, pain, and lacrimation, caused by a strain of Chlamydia trachomatis. It progresses from a mild infection with tiny follicles on the eyelid conjunctiva to invasion of the cornea, with scarring and contraction that may end in blindness.tracho´matous

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tra·cho·ma (tr-km)

n.

A contagious disease of the conjunctiva and cornea, caused by the bacterium Chlamydia trachomatis and marked by inflammation, hypertrophy, and formation of granules of adenoid tissue. It is a major cause of blindness in Asia and Africa. Also called contagious granular conjunctivitis, Egyptian ophthalmia, granular conjunctivitis, granular ophthalmia.

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trachoma

[trəkō′mə]

Etymology: Gk, roughness

a chronic infectious disease of the eye caused by the bacterium Chlamydia trachomatis. It is characterized initially by inflammation, pain, photophobia, and lacrimation. If untreated, follicles form on the upper eyelids, forming scarring that causes trichiasis and corneal sequelae, eventually causing blindness. Tetracycline, erythromycin, and azithromycin usually provide effective treatment. Scarred eyelids may be surgically repaired. Trachoma is a significant cause of blindness and is endemic to hot, dry, poverty-ridden areas. In the United States it is found in the Southwest. Teaching an affected population about the spread of trachoma and having an adequate water supply for washing hands, towels, and handkerchiefs are important factors in eliminating the disease. Also called Egyptian ophthalmia, granular conjunctivitis.

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trachoma [trah-ko´mah] (pl. tracho´mata)

a chronic infectious disease of the conjunctiva and cornea, producing photophobia, pain, and lacrimation, caused by an organism once thought to be a virus but now classified as a strain of the bacteria Chlamydia trachomatis. It is more prevalent in Africa and Asia than in other parts of the world; in North Africa few persons reach adulthood without having contracted the infection. It is fairly common in parts of the United States, such as in parts of the Southwest where a hot dry climate and scarcity of water encourage its spread. Trachoma in children and adults begins with a conjunctivitis that is marked by tiny follicles on the upper eyelids and tarsal plate. The follicles become larger and larger, and there is granulation of the cornea and impairment of vision. Eventually there is severe scarring which results in blindness. Trachoma is the world's leading cause of preventable blindness.



A condition closely related to trachoma in cause, manifestations, and epidemiologic pattern is inclusion conjunctivitis, which is fundamentally a sexually-transmitted disease of the adult genital tract. The agents of trachoma and inclusive conjunctivitis are called tric agents.

Treatment and Prevention. The drug of choice in treatment of trachoma is azithromycin; studies have demonstrated that a single oral dose eliminates the infection and prevents scarring. In areas where azithromycin is not available, tetracyclines may be used, administered topically in the form of suspensions or ointments that adhere to the conjunctiva for prolonged effect. Prevention of trachoma begins with an adequate water supply for washing the hands and bathing, control of flies, and education of the local population about the cause and spread of the disease. Early treatment of young children reduces the source of infection and avoids the complication of blindness. Repeated treatment programs for adults help control the spread of infection.

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trachoma (tr·kōˑ·m),

n an infectious, chronic disease of the eye caused by the bacterium
Chlamydia trachomatis; marked by pain, inflammation, an atypical sensitivity to light, and an excess secretion of tears. If the condition is not treated, blindness can eventually occur as a result of follicles that form on the upper eyelids and infiltrate the cornea. Effective therapeutic approaches include topi-cal sulfonamides, erythromycin, and tetracycline. Surgery can repair scarred eyelids. Also called
Egyptian ophthalmia or
granular conjunctivitis.

Trachoma.

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Trachoma 

A chronic, bilateral, contagious conjunctivitis caused by the serotypes A, Ba and C of Chlamydia trachomatis. The conjunctivitis results in conjunctival scarring (Arlt's line) and may lead to entropion and trichiasis and dry eyes. Follicles at the limbus may leave some sharply defined depressions (Herbert's pits). There is also keratitis with corneal infiltrates, pannus and vascularization. As the disease progresses there is corneal ulceration and opacification, which may result in blindness. Trachoma is one of the main causes of blindness in the world. It is a disease most commonly encountered in hot regions of the globe where hygienic conditions are poor. Treatment includes a course of tetracycline or erythromycin and surgical correction of entropion and trichiasis may be necessary. Syn. egyptian conjunctivitis; granular conjunctivitis.

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trachoma

Ophthalmology An ocular infection by Chlamydia trachomatis which, if untreated, leads to blindness Incubation period 5 to 7 days, begins as a mild conjunctivitis that develops into a fulminant infection producing large amounts of discharge, and swollen eyelids; the initial stage lasts several wks, followed by a chronic stage in which the lids remain very swollen, the cornea becomes eroded, scarred, and vascularized; the lids develop contractures and may turn outward, pulling away from the eye; 2º bacterial infections may cause blindness. See Chlamydia trachomatis.