Sunday, 17 November 2013

Eliminating Trachoma - Devi Eye Hospital Bangalore

Trachoma is the result of infection of the eye with Chlamydia trachomatis. Infection spreads from person to person, and is frequently passed from child to child and from child to mother, especially where there are shortages of water, numerous flies, and crowded living conditions.

Infection often begins during infancy or childhood and can become chronic. If left untreated, the infection eventually causes the eyelid to turn inwards, which in turn causes the eyelashes to rub on the eyeball, resulting in intense pain and scarring of the front of the eye. This ultimately leads to irreversible blindness, typically between 30 and 40 years of age.

Trachoma was once endemic in Europe and the United States. European immigrants to America had their eyelids flipped and examined upon arrival at Ellis Island in New York. Nine of 10 immigrants diagnosed with active trachoma were returned to their home countries.

Trachoma disappeared in Europe, even before antibiotics, because of improved living standards. Today, it is believed to be endemic in 53 countries, often affecting the poorest of the poor. Today, best estimates suggest that close to 110 million people live in areas where trachoma is confirmed to be endemic and implementation of the full SAFE strategy is needed. Another 210 million people live in districts where trachoma is suspected but where no data are available to guide interventions. In the confirmed districts, an estimated 4.6 million people suffer from the final stages of the disease and require surgery to prevent them from going blind. Additionally, more than 80% of the burden of active trachoma is concentrated in 14 countries, where immediate action is needed.

Trachoma destroys family

Trachoma can destroy the economic well-being of entire communities, keeping families shackled within a cycle of poverty as the disease and its long-term effects pass from one generation to the next.

Globally, trachoma results in an estimated US $2.9 billion in lost productivity per year. Blindness from trachoma strikes adults in their prime years, hindering their ability to care for themselves and their families.
Women, traditionally the caretakers of the home, are twice as likely as men to have trichiasis. When a woman can no longer perform vital activities for her household, an older daughter is often removed from school to assume her mother’s duties, thus losing her opportunity for a formal education.

A Preventable Disease

Trachoma is treatable and preventable with a multifaceted approach known as the SAFE strategy.
Recommended by the World Health Organization, the SAFE strategy is a comprehensive public health approach that combines treatment (Surgery and Antibiotics) with prevention (Facial-cleanliness and Environmental improvement).

Antibiotic treatment will provide a short-term cure, especially when the whole community is treated, but reinfection occurs usually within six months. This is why it is essential that the full SAFE strategy be in place in trachoma-endemic communities.

Even if trachoma is eliminated, trichiasis surgery will remain necessary for the population already affected and with scarring of the conjunctiva and inturned eyelashes.

Trachoma is a potentially blinding eye infection, found worldwide. Though claimed to be eradicated from India, many cases are still found with this condition.

The facts about trachoma

It is the world’s leading cause of preventable blindness.
The World Health Organization (WHO) estimates that eight million worldwide are blind due to trachoma and more than 150 million people are in need of treatment.
It occurs where people live in overcrowded conditions with limited access to sanitation.

Causes of trachoma

Trachoma is linked to extreme poverty and poor sanitation. It is triggered by bacteria that cause repeated conjunctivitis, irritating the eyes and creating a mucous discharge. Although the conjunctivitis clears up after a month or so, it is easily spread. This is particularly the case in places where there is little water for people to wash their hands and faces regularly.

How trachoma causes corneal damage:

-reducing the amount of tears produced
-making it difficult to close the eyelids (which lubricate the eye and help flush away dust and dirt)
-triggering trichiasis, where the eyelid and eyelashes turn in on the eye.

How does it spread?
The discharge from infected eyes attracts flies that then land on other people’s skin. People in crowded households or neighbourhoods are particularly vulnerable.

Tackling trachoma

Sightsavers is part of the Global Elimination of Trachoma by 2020 programme, working alongside the World Health Organization and other voluntary organisations.

Since its launch in 1998 the programme has treated more than seven million people and reduced active trachoma in children by 50 per cent.

Sightsavers follows the SAFE strategy for treating trachoma. (Surgery, Antibiotics, Facial cleanliness and Environmental hygiene).


Sightsavers trains nurses to perform surgery for trichiasis in their community. The surgery can be done at a local health clinic or even in the home, meaning that people do not have to travel huge distances to seek treatment. The operation involves removing the parts of the eyelid which are being pulled inwards, causing the lashes to touch the eye, so the eyelids turn back out again. This
-Stops the trichiasis from getting worse
-Improves vision in the short term
-Makes it much more comfortable for people
-Reduces the levels of eye discharge


Sightsavers provides two types of antibiotic to treat trachoma:
Tetracycline – ointment applied directly to the eye over a period of six weeks. Done properly, it has a success rate of 60-80%.
Oral azithromycin – this is just as medically effective as tetracycline, but because it is taken orally it is far more successful.

Problems with antibiotics:

Antibiotics have side effects. Overuse can make people immune to them. For this reason they should only be part of trachoma treatment, used with Infection-reduction methods such as facial cleanliness and good sanitation.Treatment takes a long time and is difficult to administer in rural areas.

Facial cleanliness

Children with dirty faces may be up to two times more likely to contract the trachoma virus than those without. One of the best ways to prevent the transmission of trachoma is by encouraging face and hand washing – not easy where water is scarce.
Sightsavers’ local partners are encouraging facial cleanliness through:
-Training health workers to conduct health promotion sessions in local communities, explaining the benefits of face and hand washing
-Promoting the use of the ‘leaky tin’, a cheap and easy method of face and hand washing where water is scarce
-Improving access to water
-Improving availability of soap

Environmental hygiene

The transmission of trachoma by flies can be tackled by reducing the number of flies people come into contact with. Sightsavers’ local partners helps communities to achieve this by setting up local sanitation committees to:
-Build covered latrines and encourage facial cleanliness
-Discourage people from sleeping close to their livestock, a common practice in Africa and Asia.
-Encourage villagers to collect and burn rubbish on a regular basis

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