A Family Doctor's Tale - TRACHOMA

DOC I HAVE TRACHOMA

Trachoma is a bacteria infection of the eye and eyelids which is common in developing countries especially in rural areas, crowded unhygienic communities often affecting children.

It is rare in Singapore.


Trachoma is a contagious follicular conjunctivitis of the eye and is endemic in tropical and subtropical regions.

It can be spread by flies.

Trachoma is caused by the bacteria chlamydia trachomatis.

The organism is seen in the epithelial cells from the conjunctival scrapings.

Lymphocytic infiltration of conjunctiva can be seen with aggregates of the lymphocytes forming follicles seen histologically.

Fibrosis can lead to scarring.

Secondary infections and complications are common.

Incubation period is 7 days.

The infection then involve both conjunctiva and cornea.

Trachoma can spread easily from person to person, by secretions from  infected eye, nose, or throat  or by contact with contaminated  towels or clothes

However it is not a serious health risk if diagnosed promptly.

Symptoms:
1.Redness in the white of the eye or inner eyelid

2.tears overflowing

3.lid edema

4.yellow discharge that crusts over the eyelashes, especially after sleep

5.Pain in the eyes

6.photophobia

7.Eyelids presents with red velvety surfaces on the inner linings with follicles that form over 7 to 10 days, enlarge and become infiltrated with inflammatory tissues.

8.Large follicles are diagnostic of trachoma.

9.The follicles are seen first in the lower eyelid lining but soon appear in the upper eyelid lining often forming a row along the upper margin of the eyelid.

10.Infiltration may spread deeply forming papilla(raised follicles) resulting in scarring of the eyelid and retraction of the eyelid.

Complications:
1.Trachoma can also be spread through hand contact when rubbing the eyes.

2.corneal keratitis, pannus and scarring

3.entropion of eyelids

4.Trichiatis - infection of eyelashes

Treatment:
Trachoma of eye is treated with antibiotics.

The antibiotic can be given as eye drops, ointments, or pills.

Eye drops or ointments may need to be applied to the inside of the eyelid three to four times a day for five to seven days.

The antibiotic of choice is erythromycin, septrin and tetracycline eyedrops or ointment.

Treatment must be continued for months.

Secondary infections (other bacteria or fungal) must be eliminated.

Prognosis:

Normally there is good response to early treatment

Recurrence may occur if exposed to chlamydia through sexually transmitted diseases or if the environment is unhygienic.

Trachoma is a common cause of blindness because of corneal complications.

Eyelid deformities may also occurred

Prevention:
1.Protect your eyes from dirt and flies.

2.Avoid getting chlamydia infection through safe sex.