Trachoma causes, symptoms and treatment

Imagine that a simple touch or a tiny fly could lead to a painful and distressing disease like trachoma! This eye infection is one of the most widespread diseases in areas with poor hygiene and limited healthcare, and if left untreated, it can progress to blindness in its later stages.

In this article, we’ll explore what trachoma is, how it spreads, and the best ways to prevent and treat it to protect our eyes and keep ourselves and our loved ones safe. Let’s get started!

If trachoma is not treated early and effectively, it can cause serious complications:

Blindness:

In its late stages, trachoma can lead to permanent damage to the cornea and the eye, potentially resulting in vision loss.
Additionally, eyelid deformities and inward-turning eyelashes can cause the lashes to rub against the cornea, leading to scratches and scarring.
Over time, these corneal issues can ultimately result in blindness.

Bacterial Infections:

Severe and chronic eye inflammation increases the risk of bacterial infections.
Such infections can cause corneal ulcers or severe conjunctivitis.
In advanced cases, infections can permanently destroy the cornea, leading to blindness.

Psychological and Social Impact:

Blindness or vision impairment caused by trachoma has a significant psychological and social impact.
Losing sight can affect a person’s ability to work, pursue education, and engage with society.
It may also lead to psychological distress and social isolation. However, in rare cases, some individuals have achieved great success despite blindness, such as the late Taha Hussein, the "Dean of Arabic Literature," and Sheikh Mohamed Rifaat.

Therefore, early treatment of trachoma is essential to prevent these serious complications. Early detection and effective treatment are the best solutions.

What is Trachoma?

Trachoma is a bacterial eye infection caused by Chlamydia trachomatis. If left untreated, the eyelids can turn inward, causing the eyelashes to rub against the eyeball, leading to damage to the eye’s surface. This condition, known as trichiasis, is extremely painful. Repeated infections can eventually result in blindness.

Stages of Disease Progression

The World Health Organization (WHO) classifies trachoma into five stages:

1. Follicular Inflammation (TF):

At this early stage, the infection begins to develop, and at least five small follicles appear on the inner surface of the upper eyelid. These follicles are tiny bumps filled with white blood cells and are visible under magnification.

2. Intense Inflammation (TI):

The infection becomes more severe, leading to increased eye irritation and thickening or swelling of the upper eyelid.

3. Eyelid Scarring (TS):

Repeated infections cause scarring on the inner surface of the upper eyelid. These scars often appear as white lines under magnification. In severe cases, the eyelid may become deformed and start turning inward (entropion).

4. Eyelashes Turning Inward (Trichiasis – TT):

As scarring worsens, the eyelashes begin to grow inward, rubbing against the cornea. This leads to persistent scratches, inflammation, and severe discomfort.

5. Corneal Opacification (CO):

Inflammation beneath the upper eyelid affects the cornea, causing it to become cloudy. Over time, continuous friction from inward-turned eyelashes can worsen the condition. In some cases, corneal ulcers and secondary infections develop, ultimately leading to partial or complete vision loss.

Key Points to Note:

The symptoms of trachoma are more pronounced in the upper eyelid than in the lower eyelid.
As scarring worsens, a thickened ridge may appear on the upper eyelid.
The infection can also affect the oil and tear glands in the eyelid, leading to severe dryness, which worsens the condition.

Is Trachoma a Serious Disease?

Yes, trachoma is a serious disease if not treated in time, for the following reasons:

Gradual Vision Deterioration:
- If trachoma is not treated in its early stages, it leads to chronic eye inflammation.
- This inflammation causes scarring on the eyelid, forcing the eyelashes to turn inward.
- As the eyelashes rub against the cornea, it gradually gets damaged, eventually leading to vision loss.
Blindness:
- If left untreated, vision deterioration can progress to complete blindness.
- Trachoma is one of the leading causes of preventable blindness, especially in developing countries.
Spread of Infection:
- People with trachoma can easily transmit the infection to others.
- The disease spreads rapidly in areas with poor personal hygiene and low sanitation levels.

What Causes Trachoma?

Several factors contribute to the spread of trachoma, including:

The Bacteria Causing the Disease:
- Trachoma is caused by an infection with the bacterium Chlamydia trachomatis, which survives inside human cells.
Direct Contact:
- The infection spreads from person to person through eye secretions.
- Sharing towels, tissues, or personal items with an infected person can also spread the disease.
- Sleeping in the same bed as an infected individual increases the risk of transmission.
Flies as Disease Carriers:
- Flies can transfer the bacteria from an infected person's eye to a healthy person.
- The disease thrives in overcrowded areas with poor hygiene, especially in impoverished communities.
Poor Living Conditions:
- Trachoma is more common in areas with inadequate sanitation.
- Lack of access to clean water and proper hygiene facilities accelerates its spread.
Weakened Immune System:
- Children and the elderly are more vulnerable due to weaker immune systems.
- In some poor communities, adult women are six times more likely to be infected than men.
- Repeated exposure to infection weakens immunity further, increasing the risk of developing the disease.

How to Prevent Trachoma?

To eliminate trachoma, it is essential to:

Maintain good personal hygiene.
Ensure access to clean water.
Improve living conditions.
Promote public health programs to educate people and control the spread of the disease.

What Are the Types of Trachoma?

Trachoma progresses through four main stages:

Mild Active Trachoma:
- This is the early stage of the disease.
- Small follicles (tiny bumps) appear on the inner upper eyelid.
- These follicles contain white blood cells (a type of immune cell).
- Mild inflammation and slight eye discharge may be present.
Severe Active Trachoma:
- This is a more advanced stage of the infection.
- The follicles increase in number, become larger, and cluster densely on the upper eyelid.
- The upper eyelid starts to swell and thicken.
- Severe inflammation and increased eye discharge occur.
- The risk of scarring and inward eyelash growth (trichiasis) begins to rise.
Cicatricial (Scarring) Trachoma:
- This is the late stage of the disease.
- Scarring develops on the eyelid, causing the eyelashes to turn inward.
- The cornea begins to sustain damage due to continuous friction from the eyelashes, leading to scratches.
- At this stage, there is a high risk of corneal damage and vision loss.
Blinding (Late) Trachoma:
- This is the most advanced and severe stage of trachoma.
- The inner eyelid lining becomes highly scarred and deformed, causing the eyelashes to turn further inward.
- Continuous friction and severe scratches on the cornea result in permanent damage and opacity.
- At this stage, the eye is visibly damaged.
- Blindness is almost inevitable due to severe corneal deterioration.

Why Early Treatment is Crucial?

Early treatment is essential to prevent the disease from progressing to a stage that can cause permanent vision loss.

What Are the Symptoms of Trachoma?

Trachoma starts with mild symptoms but worsens if left untreated. The symptoms are divided into three stages:

1. Early Symptoms:

Mild itching and a sensation of something foreign in the eye.
Redness and swelling of the eyelids.
Eye discharge containing mucus or pus.
General discomfort in both eyes.

2. Symptoms in the Active Stage:

Appearance of small follicles on the inner surface of the upper eyelid.
Severe eye inflammation.
Increased discharge and eye pain.

3. Symptoms in the Late (Scarring) Stage:

Inward-turning eyelashes (trichiasis), causing friction with the cornea and leading to scratches.
Scarring and deformation of the eyelids due to repeated infections.
Changes in the shape and transparency of the cornea, leading to vision deterioration.
In severe cases, vision loss or complete blindness.

Since symptoms worsen as the disease progresses, early treatment is crucial to prevent severe complications like blindness. Regular eye check-ups help detect and treat trachoma before permanent eye damage occurs.

How Long Does Trachoma Last?

The duration of trachoma infection depends on the patient's condition, the stage of the disease, and how quickly treatment is administered.

1. Early Stage (Active Trachoma):

Symptoms such as eye inflammation and discharge appear at this stage.
If untreated, this stage can last for weeks or months.

2. Advanced Stage (Scarring Trachoma):

If the disease is left untreated, it progresses to scarring and eyelid/corneal deformities.
This stage can last for years and may lead to permanent visual impairment.

3. Recurrence Stage:

Even after treatment, the disease can recur (relapse), especially if hygiene is poor or the person is in an unhealthy environment.
The risk of recurrence depends on treatment effectiveness, immune system strength, and adherence to preventive measures.

General Timeline:

Without treatment, trachoma can persist for months to years.
In advanced stages, eye deformities and vision loss can be lifelong.
Early treatment and regular medical follow-ups are crucial to prevent permanent complications.

Is There a Permanent Cure for Trachoma?

Yes, trachoma can be permanently treated, but it requires a comprehensive approach, including medical treatment, surgery (if needed), and improved hygiene practices in the community.

1. Accurate Diagnosis:

Eye examination to check for small follicles on the inner eyelid.
A swab sample from eye discharge may be tested in a laboratory to confirm the presence of Chlamydia trachomatis bacteria.
Early diagnosis is crucial for effective treatment before the disease reaches advanced stages.

2. Medication:

Antibiotics such as Azithromycin, Tetracycline, or Doxycycline kill the bacteria and stop disease progression.
Treatment may be in the form of eye ointments or oral tablets, depending on the patient’s condition.
If scarring causes dry eyes, artificial tears may be recommended.

3. Surgery (For Advanced Cases):

If severe scarring or inward eyelash growth (trichiasis) occurs, surgery can correct eyelid deformities and prevent corneal damage.
Surgery protects against permanent blindness.

4. Improving Hygiene and Public Health:

Personal hygiene: Regular face and hand washing reduces the spread of infection.
Environmental improvements: Providing clean water and better sanitation in affected communities.
Health awareness campaigns, especially for children and women, who are most vulnerable.

5. Global Efforts to Eliminate Trachoma:

Collaboration between health organizations and governments to provide free treatment, clean water, and better living conditions.
Screening and treatment campaigns in high-risk areas.

With early treatment, proper hygiene, and preventive measures, trachoma can be completely cured and even eradicated in affected communities.

Where Does Trachoma Come From?

Trachoma is caused by a bacterial infection from Chlamydia trachomatis, which spreads through various ways, including:

1. Direct Contact:

Touching infected eye secretions (tears or mucus) and then rubbing the eyes without washing hands.
Sharing personal items such as towels, pillows, cosmetics, or sleeping in the same bed as an infected person.
Close physical contact within families, schools, or daycare centers increases the risk.

2. Transmission Through Flies:

Flies that feed on infected eye discharge can carry the bacteria and spread it to other people.
Poor sanitation and stagnant water increase fly populations, worsening disease spread.

3. Personal Hygiene Factors:

Not washing hands and face regularly raises the risk of transferring bacteria from infected individuals.
Living in crowded areas makes it easier for the disease to spread due to close human contact.
Children (ages 4-6) are most at risk, as they frequently touch their eyes while playing.
Women are 2 to 6 times more likely to be infected than men, often due to close contact with infected children.

4. Environmental and Living Conditions:

Poor sanitation and low hygiene standards help the disease thrive.
Lack of clean water prevents people from washing their hands and faces regularly.
High population density increases disease transmission due to frequent interactions.

5. Travel and Migration:

Infected individuals traveling from one region to another can introduce the disease to new communities.
Close contact with local populations in new areas increases the chances of spreading the infection.

Trachoma is most common in developing countries where sanitation and hygiene levels are low. Preventing its spread requires improving cleanliness, providing clean water, and raising awareness in affected communities.

How to Stop the Spread of Trachoma

To reduce the spread of trachoma, preventive strategies must be implemented, including personal hygiene, fly control, early screening, health awareness, and environmental improvements.

1. Improve Personal and Public Hygiene:

Wash hands and face with soap and water several times daily.
Avoid sharing personal items such as towels and tissues with others.
Do not sleep in the same bed as an infected person.
Keep the surroundings clean and dispose of waste properly.

2. Fly and Insect Control:

Use insecticides to eliminate flies that carry the infection.
Improve ventilation and cleanliness in homes, schools, and workplaces.
Properly dispose of garbage and animal waste to prevent fly breeding.
Eliminate stagnant water pools, which serve as breeding grounds for insects.

3. Early Screening and Medical Treatment:

Detect and treat infected cases immediately with antibiotics such as azithromycin.
Provide effective and affordable or free treatment, especially in poor areas.
Train doctors and nurses to diagnose and manage the disease efficiently.
Conduct regular health campaigns in affected areas to detect cases early and provide necessary treatment.

4. Spread Awareness and Health Education:

Educate communities on how the disease spreads and the importance of hygiene in prevention.
Encourage healthy habits such as frequent hand and face washing.
Raise awareness about the importance of eliminating flies and insects to prevent infection.
Improve healthcare services and ensure access to medical care for everyone.

5. Environmental Improvement and Community Development:

Enhance infrastructure in affected areas and provide adequate healthcare facilities.
Ensure access to clean water and sanitation services to prevent infection.
Combat poverty and improve living conditions, as the disease is most common in poor communities.
Reduce overcrowding, as densely populated areas facilitate the rapid spread of the disease.

Conclusion:
Implementing these measures helps reduce and eliminate trachoma, especially in communities lacking proper healthcare and basic facilities. Prevention is better than cure, so improving hygiene, controlling insects, and raising health awareness are essential solutions to stopping the spread of this disease.

Natural Remedies to Help Relieve Symptoms of Trachoma

Natural remedies may help soothe the eyes and reduce symptoms, but they are not a substitute for medical treatment with antibiotics. Trachoma is a bacterial infection that requires proper medical care to avoid serious complications, such as vision loss.

Natural Remedies to Help Ease Symptoms:

1. Tea Compresses

Tea contains antioxidants that help reduce inflammation.
How to use:

Boil a cup of water and add a tea bag (or loose tea leaves).
Let it cool slightly, then soak a clean cotton pad in the tea.
Apply the compress to the affected eye for 10 minutes.

2. Chamomile

A natural soother that helps reduce redness.
How to use:

Boil water and add chamomile flowers.
Let it cool slightly, then use it as an eye compress for 5-10 minutes.

3. Aloe Vera

Known for its antibacterial and soothing properties.
How to use:

Mix aloe vera juice with egg white.
Apply the mixture as a compress on the eyes for 10 minutes.

4. Honey and Onion

Honey is anti-inflammatory, and onion contains antibacterial compounds.
How to use:

Mix equal amounts of onion juice and honey.
Use a clean cotton pad to apply the mixture to the eye once daily.

5. Anise

Contains essential oils that help reduce inflammation.
How to use:

Boil water with anise seeds and let it cool.
Use it as an eye compress for 15 minutes.

6. Thyme

A natural anti-inflammatory.
How to use:

Boil thyme leaves in water.
Drink it in the morning and evening or use it as an eye compress.

7. Coriander

Helps cleanse the eyes from impurities.
How to use:

Grind fresh coriander and mix it with egg white.
Apply the mixture to the eye for 10 minutes.

8. Fennel

Helps soothe eye irritation.
How to use:

Boil water with fennel and let it cool.
Use it as an eye wash or compress.

9. Saffron

Has antibacterial properties and helps moisturize the eyes.
How to use:

Soak saffron in lukewarm water for 10 minutes.
Use it as an eye wash.

10. Clove Oil

A natural disinfectant and eye soother.
How to use:

Apply a small drop of diluted clove oil inside the eye in the morning and evening.

Important Notes:
These natural remedies do not replace medical treatment with antibiotics.
Always consult a doctor before trying any of these remedies, especially in advanced cases.
If severe symptoms appear, such as swollen eyelids, blurred vision, or severe pain, seek immediate medical attention.

Early antibiotic treatment is the only way to eliminate the bacteria and prevent blindness.

The specialist responsible for treating trachoma is an ophthalmologist, who diagnoses the disease, prescribes antibiotic treatment, and monitors the condition to prevent complications such as scarring and vision loss.

In advanced cases affecting the eyelids or cornea, eye surgeons may perform surgical interventions to correct deformities caused by chronic inflammation.

If you experience symptoms of trachoma, it is best to consult an ophthalmologist as soon as possible to receive the appropriate treatment and avoid complications.