Trachoma is a chronic follicular conjunctivitis that leads to scarring in the conjunctiva and cornea. This disease came to prominence in Europe during the Napoleonic wars, when tens of thousands of British and French troops returned with trachoma after fighting in Egypt. It spread rapidly through the armies of Europe, where the troops lived in crowded and insanitary barracks.



Causes

Trachoma is caused by bacteria called Chlamydia trachomatis which is a similar bacterium to one that causes the sexually transmitted infection (STI) chlamydia. It is transmitted by insects, by hand-to-eye contact, or by the sharing of infected handkerchiefs or towels. The incubation period is about a week. Hands, clothing, towels and insects can all be routes for transmission. In the world's developing countries, flies are a major means of transmission. The bacteria have an incubation period of 5 to 12 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to pink eye.

Symptoms

The early symptoms of trachoma include the development of follicles (small sacs) on the conjunctivae of the upper eyelids, pain, swollen eyelids, a discharge, tearing, and sensitivity to light. If the infection is not treated, the follicles develop into large yellow or gray pimples, and small blood vessels develop inside the cornea. Symptoms if not treated :-

Thick eye discharge,

Grittiness in the eye,

Repeated conjunctivitis,

The white of the eye and eyelid becomes red and painful,

Less tears produced to lubricate the eye, and

Difficulty closing the eyelids.

Loss of vision and blindness

Treatment

The best time to treat trachoma is during childhood, before serious damage has begun. Early treatment result in full recovery and prevents loss of vision or blindness. Systemic therapy with oral antibiotics can prevent long-term complications if used early in the infection. Active antibiotics include erythromycin and its derivatives, or doxycycline. In extreme cases, eyelid surgery may be needed to correct lid deformities caused by ongoing eye infections.

For family based treatment to occur, one needs to identify in the community those families that have children with active trachoma. Families without active transmission do not need, and will not benefit from, treatment. For this purpose a family may be considered as those people who live together or share a sleeping area.