Trachoma

Trachoma (Greek: τράχωμα, " Rough eye"), and conjunctivitis ( granulosa ) trachomatosa called Egyptian trachoma or inclusion conjunctivitis trachomatous, is a bacterial inflammation of the eye with Chlamydia trachomatis (serotype A to C), which can end in blindness.

Frequency and cause

Trachoma is very rare in developed countries, but in tropical (developing ) countries with lack of hygienic conditions, the most common eye disease. About 500 million people suffer from it, about six million are blind because of it. The disease is caused by infection with Chlamydia trachomatis (serotypes A, B and C) over the direct contact between the mucous membranes of the eyes, nose and mouth. It can be transmitted through sharing of washcloths or towels or by flies.

Symptoms

Most people with the disease in early childhood trachoma. The disease is divided into four stages. After five to twelve days incubation period, the symptoms of bilateral conjunctivitis with foreign body sensation, tearing eyes and discharge of serous secretion from the eye as the first stage.

In the second stage show on the conjunctiva of the upper lid not supplied with blood vessels, gelbweißliche, little raised follicles. Through these follicles the surface of the conjunctiva of the upper eyelid looks rough, where the term originates trachoma. In addition, these inflammatory changes cause the upper eyelid swells, becomes heavier and hangs in the sequence. It is spoken by a ptosis trachomatosa. In addition, blood vessels in the conjunctiva to the top of the cornea in the cornea, which usually does not have its own blood vessels, one sprout and form a so-called pannus trachomatosus.

In the third stage, the lymph follicles melt down on the conjunctiva of the upper lid and burst. In their place now causes scars. In the fourth stage, the resulting scars in the third stage pull together on the conjunctiva of the upper lid. This pull the lid margin of the upper eyelid with his eyelashes inward toward the eyeball, called cicatricial arises. Now, the lashes rub with each blink and every eye movement to the cornea of the eye. It is spoken by a trichiasis. This constant rubbing can lead to injuries of the cornea, which become infected and heal with scar formation. The more grain to the cornea result, the greater will be the deterioration of vision. Without treatment, blindness sufferers.

Diagnosis and Therapy

The diagnosis of trachoma is made on the basis of symptom profile. For the treatment of local or systemic infection, antibiotics ( only intracellularly acting antibiotics such as macrolides and tetracyclines ) may be used. Is already a malposition occurred, the position of the upper eyelid by means of an operation must be normalized. If the cornea has been heavily scarred and seeing clearly limited, a keratoplasty can be performed with replacement of the cornea.

Differential Diagnosis

• Paratrachom
• Follicular conjunctivitis
• Vernal

Prophylaxis

In particular, improvement of hygienic and socio- economic circumstances together with an adequate drinking water supply would help to reduce the incidence of the disease.

Forecast

The prognosis depends on the stage of the disease. At the start of treatment in the early stages the prognosis is good. Blindness occurs in particular when the disease is not treated for years and there are often re- infection.

Global Programme for the Elimination of Trachoma

Therapy and prophylaxis of trachoma are summarized in the SAFE strategy of the Global Programme for the Elimination of Trachoma by the WHO:

• S = to eliminate Surgery, Surgery of the eyelids to the rubbing of the eyelashes
• A = antibiotics
• F = Facial Cleanliness, cleanliness of the face to avoid smear infections
• E = Environmental Improvement, improvement of hygiene, clean water.