Dr. Weinstock is a board-certified ophthalmologist. He practices general ophthalmology in Canton, Ohio, with a special interest in contact lenses. He holds faculty positions of Professor of Ophthalmology at the Northeastern Ohio Colleges of Medicine and Affiliate Clinical Professor in the Charles E. Schmidt College of Biomedical Science at Florida Atlantic University.
Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.
Trachoma is a contagious bacterial infection which affects the conjunctival covering of the eye, the cornea, and the eyelids. It is
often associated with poverty and lack of proper hygiene. Trachoma is caused by the Chlamydia trachomatis bacteria and is essentially totally preventable and curable. It is the leading infectious cause of blindness in the world. Approximately 80 million people in the world have active trachoma. The majority of these are children. The disease is found predominantly in poor tropical or semi-tropical countries.
How does trachoma manifest itself?
Trachoma affects the eyelids and conjunctiva (outside covering) of the eye, usually with very little discomfort until later in the disease. When infected, the conjunctival covering of the eye becomes red and irritated (inflamed). Repeated infections by the trachoma bacteria are common and, unless treated, can result in scarring of the conjunctival surface of the lids. The lids become scarred and the lid margins may turn in, causing eye irritation and pain followed by scarring of the cornea by the inward-turned lashes (trichiasis), which scrape the cornea. Corneal scarring results in decreased or total loss of vision. In order to see properly, it is necessary for the cornea (front window of the eye) to remain clear.
What is the cause of trachoma?
Although trachoma is caused by a small parasitic bacteria, poor sanitation, unclean water supply, and reduced personal and community hygiene allow the bacteria to infect and reinfect eyes of individuals living in endemic areas. Prevention of vision loss requires adequate, prompt treatment, in addition to education and teaching proper hygiene to the parents and children.
Trachoma is an ancient disease and was once prevalent throughout the world except in colder climates. It has been eliminated in more advanced countries but is still endemic in about 55 third-world nations, primarily in Africa and the Middle East. Approximately 10 million people have significant visual loss from the corneal scarring caused by trachoma.
Trachoma is spread by direct or indirect contact with eye, nose, or throat secretions of an individual with trachoma, or indirectly via flies or other insects carrying those secretions on their legs or bodies. Common denominators are poor hygiene, unsanitary water supplies, and shared towels. It is most common in small children (3-5 years of age) who spread it to their siblings, mothers, and playmates. Within endemic areas, the incidence of the infection is highly variable from village to village and concentrates in families or other pockets.
Throughout the entire world, Chlamydia trachomatis also causes sexually transmitted disease and conjunctivitis of the newborn, transmitted from the mother during the birth process.
The World Health Organization has targeted trachoma for elimination by 2020 through an innovative, multi-faceted public health strategy known as S.A.F.E.:
Surgery to correct the advanced, blinding stage of the disease (trichiasis),
Antibiotics to treat active infection,
Facial cleanliness and,
Environmental improvements in the areas of water and sanitation to reduce disease transmission
The comprehensive SAFE strategy combines measures for the treatment of active infection and trichiasis (S&A) with preventive measures to reduce disease transmission (F&E). Implementation of the full SAFE strategy in endemic areas increases the effectiveness of trachoma programs. The F and E components of SAFE, which reduce disease transmission, are particularly critical to achieving sustainable elimination of trachoma.
The "F" in the SAFE strategy refers to facial cleanliness. Because trachoma is transmitted through close personal contact, it tends to occur in clusters, often infecting entire families and communities. Children, who are more likely to touch their eyes and have unclean faces that attract eye-seeking flies, are especially vulnerable to infection, as are women,
the traditional caretakers of the home. Therefore, the promotion of good hygiene
practices, such as hand washing and the washing of children's faces at least
once a day with water, is a key step in breaking the cycle of trachoma
The "E" in the SAFE strategy refers to environmental change. Improvements in community and household sanitation, such as the provision of household latrines, help control fly populations and breeding grounds. Increased access to water facilitates good hygiene practices and is vital to achieving sustainable elimination of the disease. Separation of animal quarters from human living space, as well as safe handling of food and drinking water, are also important environmental measures that affected communities can take within a trachoma control program.