Trachoma (cont.)

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What are trachoma symptoms and signs?

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The affected individual develops redness and irritation of the eyes with tearing, which can progress through repeated new infection to scarring and visual loss.

How is trachoma diagnosed?

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Although there are bacteriologic and other tests available, trachoma is commonly diagnosed by examining the eyes and eyelids of the patient. In the rare cases seen in developed countries, the diagnosis is usually by the ophthalmologist. However, in the third world, ancillary personnel are very capable of being trained to make this diagnosis. Trachoma should be suspected from the history and symptoms. It then can be confirmed by an examination which can be performed within the community without the aid of sophisticated office equipment.

If equipment is available, the vision is measured and the eye is inspected with a slit lamp (biomicroscope), with which characteristic changes in the lids, tear film, conjunctiva, and cornea can more easily be seen.

What is the treatment for trachoma?

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The treatment is relatively simple. A single oral dose of antibiotic is the preferred treatment, plus making safe water available and teaching simple cleanliness. Because of cultural differences and widespread poverty in endemic areas, this regimen is difficult to implement on a universal scale.

The World Health Organization (WHO) developed the SAFE strategy.

  • S = surgical care
  • A = antibiotics
  • F = facial cleanliness
  • E = environmental improvement

Treatment involves screening communities for the presence of trachoma in children 1-9 years of age. When over 10 % are found to have clinical disease, the entire community is treated with antibiotics. In areas with less disease, only targeted groups are treated.

Due to the contagiousness of trachoma, it is necessary to treat all who might be in contact with the infected individuals.

The actual treatment is the onetime use of use of azithromycin (Zithromax) pills (currently the treatment of choice) or the topical use of 1% tetracycline (Achromycin) ointment.

When trachoma has progressed to inward-turning of the lashes, surgery is necessary to correct this and prevent the lashes from scarring the cornea. Performance of this surgery can be taught to nurses or other medical personnel.

If significant corneal scarring already exists, corneal transplantation surgery may be required, which should be performed by an ophthalmologist.

Medically Reviewed by a Doctor on 1/9/2014

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