Trachoma And Blindness

Introduction

Trachoma is an eye infection that is caused by a bacteria called Chlamydia trachomatis, which can result in blindness. The infection is spread through direct or indirect transfer of eye and nasal discharges of infected persons. The infection is at a higher rate in pre-school-aged children at the rate of 60-90%.

The prevalence of trachoma and blindness

Trachoma is one of the leading causes of blindness in 1.9 million people worldwide. A large number of cases are reported in rural areas of Africa, Central and South America, Asia, Australia and the Middle East. It causes 1.4% of all blindness worldwide. In 2021, 136 million people were in trachoma-endemic areas and were prone to blindness.

The importance of understanding the connection

Though preschool children are most prone to infection, as the infection is endemic, children apart from preschool children are exposed to repeated episodes of infection. The duration and frequency of eye infections reduce with an increase in age. Repeated infections cause scarring in the eyes, and this leads to blindness in individuals by the age of 30-40 years.

How does trachoma cause blindness?

The mechanism of trachoma infection involves:

Impact on the eye 

Eye infection from micro bacteria is highly contagious. Whenever one gets the infection, they present with some symptoms like redness, itching and eye discharge. These symptoms can further spread the infection.

Repeated infections and scarring

When the surrounding environment is not hygienic, and people do not follow hygienic practises like washing hands and face regularly and taking care of nasal and eye discharges, the probability of getting reinfected increases. However, due to certain situations, children are more prone to get reinfection many times during school life, leading to visible vision impairment in their adult life.

Trichiasis and corneal opacity

Repeated infections cause a change in the eye structure due to scarred tissue. The scar formed causes the eye to close permanently and also closes the eyelashes. This might result in permanent blindness.

It is found that with repeated infections, individuals get permanent disfigurement in their eyes, resulting in permanent blindness by the time they reach middle age. The World Health Organization stated the various stages of progression of the disease are:

1. Inflammation involving follicle – Initial infection caused bumps of lymphocytes deposited on the inner surface of the conjunctiva. They can be visualised with magnification 
2. Intense inflammation – Repeated infections cause thickening or swelling of the upper eyelid
3. Eyelid scarring – Repeated infections with bacteria cause scarring of the inner eyelid. With magnification, scars can be seen. The eyelid might be distorted and may turn inward into an eyeball; this condition is called entropion
4. Trichiasis and corneal clouding (opacity) – The cornea gets affected by repeated episodes of swelling. The most commonly affected is the upper eyelid rolling inwards, resulting in the clouding of the cornea

The upper eyelid is more affected than the lower eyelid. Without any interference or intervention, the disease initiates during childhood and advances into adulthood, resulting in blindness.

Impact of blindness from trachoma

Irreversibility

When the intervention is planned before the condition becomes worse, you will be able to save your vision to some extent. However, all the endemic areas of trachoma have poor medical support. This is why trachoma contributes to 1% of vision loss on a global level. 

Disability and social stigma

Disability is one issue that bothers trachoma patients, and another main issue is social stigma. Social stigma is the extreme disagreement and disapproval of a person on socially characteristic grounds. As trachoma is a contagious disease, patients often suffer from social stigma. Trachoma has become another reason for unstable marriages due to vision disability.

Economic burden

Surgery, medication and maintaining a decent quality of life are costly for people living in the endemic regions of trachoma. Therefore, the authorities have to take proper care to increase the sanitation level and distribution of required antibiotics to those in need. Surgeries have to be conducted on a subsidy that can help to increase the quality of life of the patients.^1,2

Risk factors for trachoma-related blindness

Some of the factors that can increase the chances of getting trachoma are:  

Geographic location

There are trachoma-endemic regions over the globe where there is a high incidence of infection. The various reasons behind this distribution can be explained by poor hygiene, low medical assistance, unhygienic surroundings, and low sanitation facilities.

Poor sanitation and hygiene

Poor sanitation and unhygienic conditions help the microbes spread to multiple people easily. Insects and flies have also been shown to spread the infection from person to person. Therefore, maintaining a hygienic environment can prevent the spread of infection in endemic regions.

Crowded living conditions

Crowded living conditions can cause the infection to spread easily. The bacterium can spread from an infected person to healthy individuals when they are sharing beds or rooms. 

Limited access to healthcare

When not given some sort of medical intervention, trachoma can lead to permanent vision loss. Therefore, it has been spreading in many low-income countries. 

Poverty

As the endemic regions of trachoma, they should have good medical care services. On the contrary, this is not the case. As a result, infection has been recurring, causing harmful consequences later on.² In a study conducted in 2015, the quality of life of trachoma patients gave astounding results, as it is not only affecting the vision but the overall health of the patients.³

Many programmes have to be conducted on a wide range to spread awareness of trachoma; this can help reduce the possibility of infection and progression into the terminal stages. A study conducted in 2013 where children were used as a medium to spread awareness about the disease in their families and surroundings was a great success.⁴

Diagnosis and treatment

Diagnosis through clinical examination

Your healthcare provider will diagnose trachoma by checking your history and clinical signs using a slit-lamp examination. On examination, the clinician can find:²

• Redness in the eye
• Pain in the eye
• Mild itching and irritation in the eye and eyelids 
• Discharge from eyes containing mucus and pus
• Swelling in the eyelid
• Light sensitivity (photophobia)
• Vision loss

Treatment for trachoma 

Some ways to treat trachoma include:¹

Surgery

Surgery will be done in advanced cases to prevent progression into blindness. Surgery prevents the pain of lashes rubbing against the eye. It also stops the lashes from scratching the cornea, which can prevent blindness from progression.

Antibiotics 

Antibiotics have to be administered to prevent the progression of the disease. Azithromycin is the most commonly used antibiotic. 

Facial cleanliness

Facial cleanliness is an important factor in the transmission of trachoma infection. People assigned female at birth are said to be more susceptible to infection and blindness than people assigned male at birth, as they are in close contact with the infected children in most cases. Therefore, regular washing of hands and face removal of nasal and eye discharge can help children prevent the infection.

Environmental improvement 

As trachoma is an infectious disease, maintaining hygienic surroundings is very crucial to prevent the spread of the infection.

Summary

Trachoma is an eye condition caused by a bacteria called Chlamydia trachomatis that can affect your eyesight if left untreated. Trachoma is the leading infectious cause of blindness in the world. It is contagious and can spread when one comes in contact with infected discharge from the eyes and nose, touching an infected individual’s hands or infected clothing or bedding.

A large number of cases are reported in rural areas of Africa, Central and South America, Asia, Australia and the Middle East. Even with medical advancements, trachoma has made many people blind all over the globe. Many out there are still in need of treatment but are not able to afford it. Social stigmas make it even more difficult for the infected. Medical needs have to be made as basic needs in these regions. More awareness camps and programs have to be conducted to promote sanitation and hygienic conditions that can save millions of lives from many infections. Make sure to maintain proper hand and face hygiene. When needed, please take proper medical advice and treatment to avoid further consequences.