Trachoma: Causes, Symptoms & Treatment

Trachoma, conjunctivitis trachomatosa, Egyptian eye inflammation, granular eye disease: trachoma is a disease with many names. As different as its names are, it is also dangerous, because if left untreated, trachoma can lead to blindness in the affected person when it reaches the final stage.

What is trachoma?

Trachoma is a disease of the eyes in which, more precisely, the conjunctiva becomes chronically inflamed. Doctors differentiate four stages with regard to the course of the disease. The first stage usually begins after an incubation period of up to two weeks has passed. This describes the time after infection until the onset of the first symptoms. Characteristic of this phase is the onset of conjunctivitis (inflammation of the conjunctiva). In addition, there are other symptoms typical of conjunctivitis, such as foreign body sensations in the eyes, reddened eye whites and the formation of a secretion at the corners of the eyes, which indicates the excretion of already dead bacteria. In the following second phase, lymph follicles form on the conjunctiva of the upper eyelids, so that the conjunctiva feels “rough”. Furthermore, the eyes swell due to the ongoing inflammation; in extreme cases, the upper eyelids droop in an unnatural way. In the third phase, the lymph follicles formed in the second phase burst; scarring is then the result. If trachoma remains untreated, the fourth and final phase of the disease occurs. The resulting scars literally pull the eyelids together, so that the eyelids have to yield to the pressure and the eyelashes protrude into the eyes. With each blink of the eyelashes, the eyelashes then rub against the surface of the eye, which can become injured and, if in contact with other pathogens, inflamed. If left untreated, this can cause severe eye injuries that can lead to blindness as a result of trachoma.

Causes

Trachoma is caused by serotypes A, B, and C of the bacterium Chlamydia trachomatis. The bacterium is mainly found in regions with poor hygienic conditions. Due to this fact, trachoma is considered to be largely eradicated in industrialized countries. As a bacterium, the pathogen prefers a warm, moist environment. Since infection can occur solely through smear infection with people who are already infected or else with contaminated objects, shared towels, clothing, and public washing places are considered sites of infection for trachoma.

Symptoms, complaints, and signs

The bacterium that causes the disease has an incubation period of five to 12 days, after which the individual symptoms are similar to conjunctivitis or irritation, such as red eye. However, without reinfection, the inflammation gradually subsides. Conjunctivitis is called “active trachoma” and is most common in preschool-aged children. It is characterized by white lumps on the underside of the upper eyelid and nonspecific inflammation and thickening, often accompanied by bulges. Active trachoma is often accompanied by a watery discharge. Secondary bacterial infection may occur and cause a purulent discharge. The later structural changes of trachoma are referred to as “scarring trachoma.” These include scarring in the eyelid, resulting in distortion of the eyelid. Most often, children with active trachoma do not show symptoms because the low-grade irritation and eye discharge are often thought to be normal. However, other symptoms may include: Eye discharge, swollen eyelids, trichiasis (eyelashes rubbing against the eyeball), swelling of the lymph nodes on the front of the ears, sensitivity to bright light, increased pulse, other complications of the throat and nose. The main complication is the so-called corneal ulcer, which occurs due to excessive rubbing or trichiasis with superimposed bacterial infection.

Diagnosis and course

Among the first diagnostic measures of trachoma is the clinical picture. Advanced cases, in particular, can be detected with a visual diagnosis because of their relatively pertinent clinical picture. Statements by the patient that the complaints recur repeatedly are also considered reliable indications of the presence of trachoma. Nevertheless, because of the serious consequences of a misdiagnosis, it should not stop there. For this reason, a smear test is taken as a further diagnostic measure.Here, very small tissue samples are taken from the conjunctiva of the affected person and examined in the laboratory for possible pathogens. If the pathogen Chlamydia trachomatis is detected, trachoma can then be assumed with absolute certainty. This diagnosis is particularly important in that cases of disease in the early stages of trachoma in particular look deceptively similar to ordinary conjunctivitis.

When should you see a doctor?

Disturbances in the functional activity of the eyes are signs of impaired health. If they persist or increase in extent and intensity, a doctor is needed. If vision loss occurs due to an overuse situation, in most cases, rest or a period of rest is sufficient. If vision is subsequently fully restored, no doctor needs to be consulted. If impairments persist even after a break, clarification of the cause is needed. An increased body temperature, irritability, a red coloration of the eyes or swelling of the lymph must be examined and treated. Hypersensitivity to light, palpitations, or general irregularities of the heart rhythm should also be presented to a physician. Changes in the eye discharge, dryness in the eye or peculiarities of the eyelid should be presented to a physician. In case of itching, general malaise as well as swollen eyes, a visit to the doctor is necessary. If there is a headache, a feeling of pressure around the eyes or blurred vision, medical examinations are needed to make a diagnosis. Abnormal behavior, gait unsteadiness or an increased risk of accidents are signs of a health disorder. If everyday tasks can no longer be performed due to impaired vision, the affected person needs help. A doctor must be consulted so that necessary measures can be taken. In severe cases, blindness is otherwise imminent.

Treatment and therapy

Because trachoma is a bacterial disease, it is considered to be well treatable, provided that treatment is given in a timely manner. The World Health Organization (WHO for short) recommends what is known as “SAFE therapy.” The “S” stands for Surgery. The eye injuries that occur in the last stage as a result of the deformation of the eyelids should be surgically removed in order to prevent eye injuries as one of the basic conditions for later complications. The “A” stands for Antibiotics, which is used to kill the trachoma pathogen. The “F” for Facial Cleanliness or hygienic environment of the visual field pursues the goal of preventing at least further infections of the already weakened eye area by keeping the facial skin as free of germs as possible. Finally, the “E” stands for Environmental Improvement, i.e. compliance with basic hygienic rules. After all, poor hygiene conditions are considered the main cause of the spread of trachoma.

Prevention

Trachoma is considered largely eradicated in Europe. This is mainly thanks to high hygiene standards. However, this does not only include regular hand washing. Risk groups in particular, such as contact lens wearers, should pay attention to special safety measures. For example, contact lenses should not be used together with strangers. The same applies to all other shared items that are likely to be used on the face, such as the example of bath towels mentioned above. If contact with a possible carrier of the pathogen nevertheless occurs, disinfection of the hands with 70% alcoholic skin disinfectants is already sufficient to kill the pathogens of trachoma already on the skin.

Follow-up

Treatment recommendations for follow-up care of trachoma do not exist. This is because in the final stage of the disease, the affected person is blind. Basically, he is then considered helpless and must learn to cope with his blindness in everyday life. In order to learn how to deal with the blindness, the affected person must first receive regular psychological care. In addition, he is dependent on an accompanying person to perform everyday tasks. However, trachoma is a gradual process. Provided that the trachoma is diagnosed in time and treated in time (with antibiotics or surgery on the upper eyelid of the eye), it can be the task of aftercare to prevent a new disease of the eye. Aftercare then includes the measures of preventive care. The aim is to eliminate the causes of the disease.Trachoma is almost exclusively caused by poor hygiene. Improving general hygiene measures and adequate personal hygiene can counteract new cases of trachoma during follow-up care. In particular, the face should be washed regularly, and home hygiene in general should be reviewed. Norms or standards should be developed and adhered to for home hygiene in order to avoid smear infections. Flies can also be a trigger for the disease. For the follow-up of trachoma, their spread should be contained by disinfecting measures.

What you can do yourself

Adherence to everyday tips can sometimes prevent the occurrence of a disease or even contribute to recovery. Therefore, it is not always necessary to consult a doctor. The discomfort of trachoma is best avoided by maintaining basic hygiene standards. These are omnipresent in Western industrialized nations, which is why the disease hardly ever occurs here. When traveling to countries with inadequate water supplies, people should definitely prefer upscale accommodations. One should never sleep in beds that have already been used. Towels that come into contact with the eye must be fresh. In addition, the use of disinfectants is recommended. A minimal risk exists in this country for contact lens wearers. Infection is prevented by hygienic storage and use of visual aids. If affected by trachoma, it is essential to consult a doctor. Self-treatment is not advisable. In the worst case, there is a risk of blindness if the disease recurs over a period of years. The only suitable treatment is medication with antibiotics. Other alternative cures apart from basic recommendations such as sparing and a balanced diet are not known.