Though this horribly disabling disease is virtually unknown to many Americans, trachoma is responsible for an estimated 7-8 million cases of permanent blindness particularly in the Middle East and Africa.
The organism that causes trachoma is Chlamydia trachomatis serovars A-C. These types are different from the types of Chlamydia that commonly cause the sexually transmitted infection that is so prevalent here in the United States.
Not only is trachoma a health issue in Africa and the Middle East but it is also endemic on the Indian subcontinent, Southeast Asia and China. Pockets of trachoma are seen in Latin America and Australia. It is estimated that 84 million people, particularly children and mothers are infected in over 50 countries.
This is definite a disease of the poor with poverty, poor personal hygiene and crowded living conditions being a few of the main factors contributing to its spread. It is also more commonly found in areas where the climate is dusty and dry.
The infectious agent is transmitted person to person through contact with eye or nasal discharges on fingers and indirectly through the use of contaminated items such as towels, pillows and clothes items like a mother’s shawl.
Flies are also a carrier of the contaminated discharge from person to person after feeding on the eye discharge of an infected person. In Africa and the Middle East, a specific specie of fly, Musca sorbens, is responsible for much of the spread.
Initially the infection resemble “pink eye” where there is inflammation of the eye, pain and sensitivity to light. Also the eye produces a watery discharge and the infection and inflammation resolves itself. The severity of trachoma is the result of frequent reinfection of the eye which over time causes scarring on the inner upper eyelid.
The resulting network of scarring over time causes an in-turning of the eyelashes (trichiasis) and entropian.
This results in a chronic abrasion of the cornea from the contact from the eyelashes. The scratching of the cornea also results in additional eye infections which in combination cause the cornea to turn opaque and blindness is the final result.
This endemic childhood disease is seen in up to 90 percent of children in rural areas of the countries listed above. Women, due to taking care of children are at least 3 times more likely to get infected than men.
The World Health Organization (WHO) has developed the S.A.F.E. strategy to control and prevent trachoma. It consists of lid surgery (S), antibiotics (A), teaching kids to keep their face clean and personal hygiene (F), better sanitation and waste disposal or the environmental factors (E).