1. Trachoma – the world’s problemTrachoma – the world’s problem

2. TrachomaTrachoma
 Affected more than 21 million people
 2.2 million are visually impaired
 1.2 million are blind
 Around 180 million people worldwide live in
areas with high risk of trachoma
 Appears in young adulthood and in middle-
aged persons
 Adult women are at much greater risk than
adult men

3.  It was once endemic in most
countries
 Now is presents for more than 3%
of the world’s blindness in poor rural
areas of Africa, Asia, Central and
South America , Australia and the
Middle East

7. More Statistics (I)More Statistics (I)
 AroundAround 285 million285 million people are visuallypeople are visually
impaired worldwideimpaired worldwide
 39 million39 million are blind,are blind, 246246 have low visionhave low vision
 80% of all visual impairment is avoidable (can80% of all visual impairment is avoidable (can
be prevented or cured)be prevented or cured)
 GloballyGlobally 153 million153 million people over 5 years of agepeople over 5 years of age
are visually impaired as a result of uncorrectedare visually impaired as a result of uncorrected
refractive errorsrefractive errors

8. More Statistics (II)More Statistics (II)
 AboutAbout 65%65% of all people who are visuallyof all people who are visually
impaired are agedimpaired are aged 5050 and older, while this ageand older, while this age
group comprises aboutgroup comprises about 20% of the world’s20% of the world’s
populationpopulation..
 An estimatedAn estimated 19 million children19 million children are visuallyare visually
impaired. Of these,impaired. Of these, 12 million children12 million children areare
visually impaired due to refractive errors; 1.4visually impaired due to refractive errors; 1.4
million are blind.million are blind.
(October 2011, WHO)(October 2011, WHO)

9. caused by thecaused by the
Chlamydia trachomatisChlamydia trachomatis bacteriumbacterium

10. Chlamydia trachomatisChlamydia trachomatis
 obligate intracellular humanobligate intracellular human
 pathogen, is one of threepathogen, is one of three
 bacterial species in thebacterial species in the genusgenus
 ChlamydiaChlamydia
 gram-negative, coccoid bacterium that typicallygram-negative, coccoid bacterium that typically
infects columnar epithelial cellsinfects columnar epithelial cells
 It exhibits a characteristic two-stageIt exhibits a characteristic two-stage
developmental lifecycle consisting of spore-likedevelopmental lifecycle consisting of spore-like

11. Life cycleLife cycle

12. Vectors - severalVectors - several synanthropicsynanthropic
muscid flysmuscid flys

13. Three types of TrachomaThree types of Trachoma
 Acute trachomaAcute trachoma
 Recurring trachomaRecurring trachoma
 Chronic TrachomaChronic Trachoma

14. Acute trachomaAcute trachoma
 It is frequently found in children who areIt is frequently found in children who are
dirty, dusty and unhealthy. It usually affectsdirty, dusty and unhealthy. It usually affects
one eye and gradually spreads to both theone eye and gradually spreads to both the
eyes.eyes.
Recurring trachomaRecurring trachoma
 If poor hygiene persists the person getsIf poor hygiene persists the person gets
affected again and againaffected again and again

15. Chronic TrachomaChronic Trachoma
 It causes inward turning of the eyelid suchIt causes inward turning of the eyelid such
that the eye lashes rub against the cornea .that the eye lashes rub against the cornea .
• Leads to blindness between the age of 30 to 40Leads to blindness between the age of 30 to 40
years if left untreated. If it does not lead toyears if left untreated. If it does not lead to
blindness, it leads to scarring of the of the corneablindness, it leads to scarring of the of the cornea
of the eye.of the eye.

16. General SymptomsGeneral Symptoms
 painful eyespainful eyes
 swollen eyelidsswollen eyelids
 slimy discharge from the eyesslimy discharge from the eyes
 inward protraction of the eyelashesinward protraction of the eyelashes
 itching of the eyes and earitching of the eyes and ear
 nose and throat infectionnose and throat infection

17. DetectionDetection
 AnAn rRNA-basedrRNA-based assay andassay and PCRPCR werewere
performed on swab specimens taken from theperformed on swab specimens taken from the
right upper tarsal conjunctiva of 240 childrenright upper tarsal conjunctiva of 240 children
aged 1 to 5 years living among 16 endemicaged 1 to 5 years living among 16 endemic
villages in the Gurage Zone, Ethiopia.villages in the Gurage Zone, Ethiopia.
 TheThe rRNA-basedrRNA-based test detected ocular C.test detected ocular C.
trachomatis infection in 142 (59%) subjectstrachomatis infection in 142 (59%) subjects
compared with 67 (28%) detected bycompared with 67 (28%) detected by PCRPCR

18. Conclusion:Conclusion:
 TheThe rRNA-basedrRNA-based test appears to havetest appears to have
significantly greater sensitivity than PCR forsignificantly greater sensitivity than PCR for
the detection of ocular C. trachomatisthe detection of ocular C. trachomatis
infection in children in trachoma-endemicinfection in children in trachoma-endemic
villages.villages.

19. PreventionPrevention
 Maintaining good hygiene and sanitation areMaintaining good hygiene and sanitation are
essential to prevent this disease of theessential to prevent this disease of the
developing countries which has beendeveloping countries which has been
eradicated from the developed countries.eradicated from the developed countries.

20. Some steps:Some steps:
1)1) Avoid physical contact with a person suffering fromAvoid physical contact with a person suffering from
trachomatrachoma
2)2) Personal cleanliness (especially face and hands)Personal cleanliness (especially face and hands)
3)3) Washing hands and face frequently in children who areWashing hands and face frequently in children who are
already infected to prevent re-infectionalready infected to prevent re-infection
4)4) Keep separate towels, handkerchiefs and linens forKeep separate towels, handkerchiefs and linens for
each member of the family.each member of the family.
5)5) Keep the food covered and use latrines and toilets forKeep the food covered and use latrines and toilets for
defecation to prevent breeding of flies.defecation to prevent breeding of flies.

21. Treatment - antibioticsTreatment - antibiotics
 There isThere is no vaccine availableno vaccine available
 Antibiotics can prevent long-termAntibiotics can prevent long-term
complications if used early in the infection.complications if used early in the infection.
Antibiotics includeAntibiotics include erythromycin anderythromycin and
doxycyclinedoxycycline..

22. AlsoAlso
 Other medications are aOther medications are a tetracyclinetetracycline eyeeye
ointmentointment and anand an oral azithromycinoral azithromycin known asknown as
ZithromaxZithromax..
 Although the oral azithromycin has beenAlthough the oral azithromycin has been
found to be more effective, one of the biggestfound to be more effective, one of the biggest
issues is that it is more expensive than theissues is that it is more expensive than the
ointment.ointment.

23.  SurgerySurgery - given to those who are- given to those who are
experiencing the more severe symptoms ofexperiencing the more severe symptoms of
trachoma.trachoma.
 One surgery isOne surgery is eyelid rotation surgeryeyelid rotation surgery, where, where
the doctor moves the eyelids away from thethe doctor moves the eyelids away from the
corneas. This surgery is done in order tocorneas. This surgery is done in order to
prevent scarring of the eyelid, and it generallyprevent scarring of the eyelid, and it generally
is done on an outpatient basis.is done on an outpatient basis.
Treatment-surgeryTreatment-surgery

24. AlsoAlso
 AlsoAlso cornea graftingcornea grafting can be performed, whichcan be performed, which
is when the corneas are replaced in the eyesis when the corneas are replaced in the eyes
from donor.from donor.
• Cornea grafting is an expensive procedureCornea grafting is an expensive procedure
that is often not available to those who needthat is often not available to those who need
it. One of the biggest problems with thisit. One of the biggest problems with this
procedure is there is always a chance thatprocedure is there is always a chance that
corneas will be rejected.corneas will be rejected.