Trachoma is a keratoconjunctivitis Chlamydia trachomatis, highly contagious, endemic in poor rural areas of Africa, Asia, Central and South America and the Middle East.
Infection is acquired from infancy by direct or indirect contact (dirty hands, contaminated towels, flies). In the absence of hygiene and effective treatment, inflammation intensifies as and infection, causing scarring on the inside of the eyelid. The eyelashes then deflect inwards (trichiasis) and in turn cause damage to the cornea and permanent blindness, usually in adulthood.
There are 5 clinical stages according to the WHO simplified classification. It is essential to diagnose and treat the early stages to avoid the appearance of trichiasis, responsible for trachoma complications.
Clinical signs:
One patient could develop several stages simultaneously:
– Stage 1: inflammation follicular trachoma (TF)
The presence of 5 or more follicles on the conjunctiva of the upper eyelid (tarsal conjunctiva). Follicles are white, gray or yellow protuberances, paler than the adjacent conjunctiva.
– Stage 2: Inflammation intense trachoma (TI)
The conjunctiva of the upper eyelid is red, rough, thickened. Blood vessels, usually visible are hidden by a diffuse inflammatory infiltration or follicles.
– Stage 3: trachoma scarring (TS)
The follicles gradually disappear, giving way to scars: lines, white lines or tracks on the conjunctiva of the upper eyelid.
– Stage 4: trichiasis (TT)
The multiple scars eyelid retraction (entropion); eyelashes deflect inwardly of the eye, rubbing against the cornea and cause ulcerations and chronic inflammation.
– Stage 5: corneal opacity (CO)
The cornea becomes progressively opaque, resulting in decreased visual acuity or blindness.
Treatment:
– Stages 1 and 2:
• Clean eyes and face several times a day
• Anti-biotherapy :
The treatment of choice is azithromycin PO:
Children over 6 months or over 6 kg: 20 mg / kg single dose
Adult: 1 g single dose
Otherwise, tetracycline eye ointment 1%: 2 applications / day for 6 weeks in children under 6 months or less than 6 kg: erythromycin PO (40 mg / kg / day in 2 divided doses for 14 days)
– Stage 3: no treatment
– Stage 4: surgery
While waiting for surgery, if the patient can be monitored regularly, restraining turned eyelashes is a palliative measure that can help protect the cornea. It allows in some cases a durable correction of trichiasis within months.
The method is to glue them turned eyelashes on the outer lid with a thin strip of tape, making sure that the opening and closing of the lid are perfect. Renew the tape whenever it is off (usually once a week); continue treatment 3 months.
Note: waxing eyelash diverted is not recommended because it temporarily relieves the patient but the eyelashes are more abrasive to the cornea during regrowth.
– Stage 5: no treatment
Prevention:
Clean the eyes, face and hands with clean water will reduce the direct transmission and prevent secondary bacterial infections.
