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Trachoma. Acknowledgement. Materials from the WHO programme for prevention of blindness is used for this presentation. Introduction. Ocular infection with clamidia trachomatis serovars A,B,Ba and C Second leading cause of blindness worldwide

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Acknowledgement l.jpg
Acknowledgement

  • Materials from the WHO programme for prevention of blindness is used for this presentation


Introduction l.jpg
Introduction

  • Ocular infection with clamidia trachomatis serovars A,B,Ba and C

  • Second leading cause of blindness worldwide

  • Disappearance in Europe and America predated antibiotics


Pathogenesis of trachoma blindness l.jpg
Pathogenesis of trachoma blindness

  • Normal conjunctiva

  • Trachoma conjunctivitis and re-infection

  • Secondary bacterial infections

  • Scarring

  • Trichiasis

  • Corneal opacity

  • Blindness


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Magnitude of the problem

  • 590 million people at risk from blinding trachoma

  • 150 million people have active trachoma

  • 10.6 million people have trichiasis

  • 5.9 million people blind from trachoma

  • 15% of global blindness: 2nd cause of blindness



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Distribution of disease

  • Trachoma is concentrated in hot, dusty, dry parts of the world. Proxy for poverty

  • Within endemic countries, trachoma is found in areas that are:

    • Rural

    • Economically underdeveloped

    • Without good water supplies

    • Without basic sanitation

  • Since it is an infectious disease, trachoma clusters at neighbourhood and household level


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Intervention: SAFE strategy

  • Surgery for trichiasis

  • Antibiotics for TF/TI

  • Facial cleanliness to prevent transmission

    of C. trachomatis

  • Environmental change to prevent

    transmission of C. trachomatis


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Transmission of Infection

  • Transmission of chlamydia from ocular and nasal secretion of children

    • Direct spread during play/sharing a bed

    • Conveyance on fingers

    • Indirect spread on fomites

    • Eye-seeking flies

    • Coughing/sneezing


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Disruption of Infection cycle

  • Antibiotics

  • Faces, Fingers, Fomites and Flies: Hygiene

  • Environmental changes:

    • water provision and use

    • Overcrowded housing

    • Domestic waste management

    • Animal proximity to household


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Which antibiotic?

Tetracycline ointment b.d. for 6 weeks

Cures 60-80% of cases of TF/TI if full course is administered; compliance a problem


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Which antibiotic?

Oral azithromycin

More effective than tetracycline in normal programme conditions


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Role of Optometrists

  • Training

  • Education

  • Community diagnosis

  • Refraction/correction

  • Low vision aids