Trachoma

Antibiotics, in conjunction with facial cleanliness campaigns and environmental improvements targeted at communities at risk, aim to reduce the reservoir of infection within a population.

Occurs predominantly in children. Poor facial cleanliness may be the most important modifiable risk factor in children who develop trachoma.

Children who have had multiple or severe episodes of active trachoma may develop cicatricial disease in later life.

Trachomatous cicatricial disease is characterized by tarsal conjunctival scarring, predominantly of the upper lid, although scarring may be sub-epithelial and not always patent. It may ensue over the subsequent decades and can lead to trachomatous trichiasis (the contact of 1 or more lashes on any part of the globe), corneal opacity, and subsequent loss of vision.

Prompt surgery must be offered to all patients who have trichiasis in order to prevent blindness.

Trachoma is a keratoconjunctivitis caused by ocular infection with Chlamydia trachomatis (serovars A, B, Ba, and C). Inflammatory episodes in adults tend to be shorter and less severe than in children. Repeated infections lead to recurrent episodes of chronic inflammation that may progress to scarring of the upper tarsal conjunctiva. The scarring results in distortion of the upper eyelid, and this can cause lashes to turn inward and abrade the cornea. This is called trachomatous trichiasis and, unless surgically corrected, will rapidly lead to corneal opacity and blindness.

Chlamydial conjunctivitis caused by the sexually transmitted strains of C trachomatis (serotypes D to K) is a separate, self-limiting infection.