Trachoma

Trachoma (Ancient Greek: "rough eye") is an infectious eye disease, and the leading cause of the world’s preventable blindness. Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease. Globally this disease results in an estimated US $2.9 billion in lost productivity every year.

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Causes

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 effects are often not felt until adulthood.

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 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.

The World Health Organization (WHO) has set a goal of eliminating blinding trachoma as a public health concern by 2020. 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.

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."

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.

History

The disease is one of the earliest recorded eye afflictions, having been identified as early as 27 B.C. Today, most victims of trachoma live in underdeveloped and poverty-stricken countries in Africa, the Middle East, and Asia. Rare in the United States, the disease can be treated with antibiotics and prevented with adequate hygiene and education. According to the Centers for Disease Control, "No national or international surveillance [for trachoma] exists. Blindness due to trachoma has been eliminated from the United States. The last cases were found among American Indian populations and in Appalachia."^[1]

In 1913, President Woodrow Wilson signed an act designating funds for the eradication of the disease.^[2] By the late 1930s, a number of ophthalmologists reported success in treating trachoma with sulfonamide antibiotics^[3]. In 1948, Vincent Tabone (who was later to become the President of Malta) was entrusted with the supervision of a campaign in Malta to treat trachoma using sulfonamide tablets and drops. ^[4]

Although by the 1950s, trachoma had virtually disappeared from the industrialized world, thanks to improved sanitation and overall living conditions, it continues to plague the developing world. This potentially blinding disease remains endemic in the poorest regions of Africa, Asia, and the Middle East and in some parts of Latin America and Australia. Currently, 8 million people are visually impaired as a result of trachoma, and 84 million suffer from active infection. The people that went through Ellis Island had to be checked for trachoma.

References

See also

• Keratoconjunctivitis