Trachoma: Causes, Symptoms, Stages and Prevention

Trachoma

Trachoma is a rare disease that is a result of a bacterial infection that affects the eyes. This disease is caused by a bacterium that is known as Chlamydia trachomatis. This infection is often a transmissible disease, and it is contagious.

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It is usually spread when an uninfected person comes in contact with the secretions of either an infected eye, eyelids, nose as well as throat of an infected person.

Asides the spread of this infection by contact with the secretions of an infected person, if an uninfected person comes in contact with the handkerchief or face towel that has been used by an infected person, the other may likely become infected as well.

Generally, the first symptom that a person with trachoma experiences is itchiness. The patient will experience itching in the eye and eyelids alongside inflammation of the eyelids. One may also notice the sudden development and leaking of pus, which, if left untreated, can cause blindness.

Among the leading causes of blindness, trachoma is one that can be prevented. According to the World Health Organization(W.H.O), they have estimated the number of people who have been blinded as a result of untreated trachoma to be about 2 million worldwide.

According to research, most of the trachoma cases that later turns to blindness occurs in the underdeveloped countries in Africa. In these areas where trachoma can be considered as prevalent, children who are under five or between the ages of 2-7 years are more at risk, with the percentage risk estimated to be between 60%-65%.

Causes

Trachoma is caused by the bacterium Chlamydia trachomatis. Generally, there are about four types of Chlamydia trachomatis that cause trachoma, and they include types A, type B, type Ba, and type C.

Also, some types of Chlamydia trachomatis such as type D- type k is mainly as a result of sexually transmitted chlamydia infection.

One general risk factor that is associated with Chlamydia trachomatis is having to live in an area with poor sanitation and unclean water supply. Also, the lack of regular face washing causes the bacteria to infect the eyes of those who are living in areas that are considered to be trachoma-endemic places.

Most times, the disease can be spread from one child to another, especially when they are with their parents, their siblings, caregivers as well as their playmates. In adults, women who are caregivers are often more at risk than any group.

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Asides human to human transmission, this infection can also be transmitted when an uninfected person comes in contact with infected material such as a handkerchief, clothing as well as towels.

Symptoms

More often than not, trachoma affects both eyes. The signs and symptoms experienced by the patient include:

  1. Mild itching, as well as the irritation of the eyelids and the eyes
  2. Production of mucus and pus from the eyes
  3. Inflammation of the internal linings of the eyelids.
  4. Photophobia which is characterized by hypersensitivity to light.
  5. Severe pains

Children are considered to always be more at risk when it comes to developing any infection, including trachoma. When a child gets a disease, usually, the child will begin to show symptoms almost immediately.

However, in the case of trachoma, this is not the case.

A child can have trachoma, which may not show signs but it keeps progressing over time. When the child later grows up into adulthood, the person will begin to experience severe problems.

Stages of Trachoma

According to the World Health Organisation, in almost all cases of trachoma, there are five different stages of development. They include:

1. Follicular Inflammation

Follicular inflammation simply refers to the swelling of the follicles. This usually occurs at the beginning of the disease. Follicles are tiny bumps of sacs that contain lymphocytes, which is a type of white blood cell present in humans.

When about five or more follicles of the eyes suddenly begin to swell just under the conjunctiva (the internal part of the eyelids), then the person can be said to within the beginning stages of developing trachoma.

Mostly this inflammation isn’t seen with the naked eyes. The swelling of the follicles of the conjunctiva is mainly seen under the microscope.

2. Intense Inflammation

In this stage, more follicles start to swell, and as such, the infection begins to spread. At this point, the eyelid starts to thicken and swell.

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3. Scarring of the eyelid

When this infection begins to reoccur often, it will cause the inner eyelid to begin to scar. Often, these scars appear in the form of white lines upon the conjunctiva when placed upon under the microscope for viewing.

Macroscopically, the eyelid tends to begin to distort and turn in, causing entropion to occur.

4. Trichiasis

Trichiasis is a condition in which the eyelashes begin to grow inward instead of outwards.

This condition is often caused when the inner lining of the eyelids, which has been previously scarred continues to be deformed and as such causing the lashes to turn in so that they can continue to rub on and scratch the cornea which is the transparent lining of the eye.

Once this occurs, the next stage begins.

5. Clouding of the cornea

Once the lashes begin to rub into the cornea, it forms an inflammation, which in turn causes the cornea to become affected. This inflammation is usually visibly seen under the upper eyelid.

When the inflammation is continuous as well as the scratching from the lashes that are now turned inside, it causes the cornea to become clouded hence causing trachoma.

It is important to note that these stages of trachoma often only occur in the upper eyelid rather than the lower eyelid. When the scarring becomes severe, it may cause a thick line to appear just beneath your upper eyelid.

Also, the glands that are responsible for lubricating our eyes, such as the tear gland, which is also known as the lacrimal gland, may be affected. Once these glands are affected, it will reduce or stop their secretion, and as a result, dryness of the eyes will occur.

Once this happens, it will cause further problems for the eye.

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Risk Factors

There are certain factors that can increase one’s chances of developing trachoma. They include:

1. Poverty

According to research, it has been seen that trachoma is prevalent in third world countries as well as in developing countries. Hence, people who are living in these regions have higher chances of developing this infection.

2. Living in crowded places

People who stay in crowded areas are at risk of developing this infection. This is because, if anyone suddenly develops trachoma, there is every tendency that he or she will pass it to those who are within close distance to him or her.

If there are a lot of people staying with the infected person, it causes the tendency of being infected to increase.

3. Poor sanitation

Bacteria are everywhere. Poorly sanitized areas, as well as crowded areas, tend to harbor much more bacteria than places that are considered to be relatively clean. Lack of proper hygiene also tends to promote the spread of this bacteria.

This is because trachoma can be gotten from unclean hands, which can be used to touch the face at any time, infecting the person.

4. Age

Children who are within the ages of three to five years are mostly more at risk. In areas where this disease is more active, kids within this age group are found to be more affected than other people.

5. Sex

According to research, women are more susceptible to this disease than men. Scientists say that in some places, women are two to six times more vulnerable than men when it comes to contracting this disease.

6. Flies

Flies have been seen to be one way by which infections can be transferred from one person to another. People who stay in areas where it is difficult to control the infestation of flies are at a higher risk of contracting this infection.

7. Lack of restrooms

In areas where people lack the provision of latrines or find it difficult to keep their toilet clean, they have a higher risk of developing this infection.

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Once this occurs, they also are at risk of dealing with the infestation of flies, which can, in turn, cause the people who are found in such places, at an increased disadvantage.

What are the complications that are attached to the trachoma infection?

Once trachoma is caught and treated early using antibiotics, there will be no problems. However, if after the initial infection, there are repeated episodes, it can lead to several complications such as;

  1. Scarring of the internal lignin of the eyelids especially the upper eyelid.
  2. Deformities of the eye such as entropion (which is characterized by the folding of the eyelid internally) as well as the trichiasis (which is characterized by the internal growth of eyelashes.)
  3. Scarring of the cornea which can result in cornea cloudiness.
  4. If left untreated for an extended period, it can cause partial or full vision loss (blindness).

Prevention

We can’t talk about the infection and its complications without having to talk about the preventive measures one is expected to take. If you have had trachoma infection and you have been treated, there is a tendency that the disease may return.

Hence, for your protection, it is better for all the members of your family as well as those who live with you to be screened, and if there is any need for treatment, appropriate antibiotics should be given.

Trachoma is a common infection that can affect the entire world; however, it is prevalent in the Middle East, Sub-Saharan Africa, North Africa, China, as well as Southern Asia. When you find yourself in a region where trachoma is widespread, do take extra care in keeping good hygiene, which helps in keeping the infection far from you.

Hygiene practices, such as the following, are primarily encouraged;

  1. Hand-washing, as well as washing of your face, frequently helps to break the spread of the infection.
  2. You must ensure that flies are well controlled in your environment.
  3. You must make sure that you dispose of all wastes properly. Remember that all human and animal wastes must be disposed of properly.
  4. Make sure that clean water is always available.

There is no vaccination that can help prevent the spread of trachoma infection. However, you can avoid it by practicing good hygiene.

References;

Deborah Akinola
Wirter, poet and public speaker