1. What is trachoma?
Trachoma is a common infectious eye disease, a chronic infectious conjunctival keratitis caused by the microorganism Chlamydia trachomatis. It is called trachoma because it forms a rough, uneven appearance on the surface of the lid conjunctiva that resembles grains of sand. Infection of trachoma can continue for several years or even decades, and the severity of its disease and lesions is closely related to environmental health and living conditions. Before the liberation of China, the prevalence of trachoma was more than 50% of the country's total. Since the founding of the People's Republic of China, the prevalence of trachoma has dropped significantly, but trachoma is still one of the major blinding eye diseases in China. According to the report of the National Symposium on Assessment and Control of Trachoma held in Kunming in 1999, the prevalence of trachoma in many areas of China is still as high as 20% or more. For example, in Anhui, trachoma inflammation amounted to 10.2%, and trachoma impaction amounted to 11.5%. In Sichuan, trachoma inflammation amounted to 20%, and trachoma impaction was 1.2%. In China's ethnic minority areas, Yunnan, Ningxia, Hainan trachoma prevalence is higher, so trachoma is listed as one of the vision 2020 elimination of avoidable blindness in the five eye diseases.
2, trachoma has what performance?
Trachoma infection early caused by varying degrees of fear of light, tearing, itching, foreign body sensation, increased secretion and other ocular discomfort, eyelid conjunctival vascular congestion, papillary hyperplasia, follicle formation, the severe cases can infringe on the cornea and corneal vascular cataracts occur. In severe cases, the cornea may be invaded and corneal vascular opacities may occur. When there are active vascular opacities on the cornea, the irritation symptoms become significant and the visual acuity is reduced. In advanced cases, severe scarring of the lid conjunctiva occurs, causing the eyelashes to grow inward and form trichiasis. Continuous rubbing of the eyelashes against the cornea causes corneal clouding and white scarring, and in the late stages the symptoms are often more pronounced due to sequelae, such as lid inversion, inverted eyelashes, corneal ulcers, and dryness of the eyeballs, and the vision is severely affected.
3. How to recognize trachoma?
Trachoma has five main signs. A patient with trachoma can have more than one of these signs at a time, and the WHO has developed a simplified grading system for recognizing and naming these signs.
1) Trachomatous inflammation-follicular (TF): this is the first sign of trachoma and is most commonly seen in children, with redness of the eye, mucus, itchy eyes, eye pain, and other discomforts, and small white dots called follicles on the conjunctival surface of the eyelid (when the eyelid is rolled over to look at them).
(2) Trachomatous intense-inflammation (TI): The second sign, trachomatous intense-inflammation (TI), is recognized when the conjunctival surface of the upper eyelid is severely red and swollen, with inflammatory thickening that blurs the blood vessels.
(3) Trachomatous scarring (TS): after repeated infections a third sign is seen i.e. scarring sign on the conjunctival surface of the eyelid - the conjunctival surface of the eyelid looks like white streaks.
(4) Trachomatous Trichiasis (TT): When scarring causes thickening of the inner layer of the eyelid and a change in the shape of the eyelid, it pulls the eyelashes downward to point toward the eyeball, and the eyelashes rub against the cornea, which is known as a trichiasis, and this is where the fourth sign of Trachomatous Trichiasis (TT) occurs.
(5) Corneal clouding (CO): if the impingement continues to rub the cornea and it looks like the cornea, which should be clear, is whitish, this is known as the fifth sign, corneal clouding.
4. How is trachoma spread?
The pathogenic microorganisms of trachoma are easily transmitted from one person to another through many different ways. People with trachoma often have red eyes and sticky discharge, and sometimes a runny nose, the discharge contains trachoma pathogenic microorganisms, it is easy to spread to the fingers, clothing, towels, washcloths and other items touched, when people are in close contact, trachoma pathogenic microorganisms can easily be spread through the interaction of fingers, clothing, and items contact; when the flies fly to the eyes to look for water or food will contain the eye secretion (containing trachoma pathogenic microorganisms) from the eyes, and the eye secretion (containing trachoma pathogenic microorganisms) from the eyes. containing trachoma microorganisms) from one person to others. All of the above can lead to repeated infections, thus increasing the severity of trachoma inflammation. It can be seen that the spread of trachoma is closely related to the patient's hygiene habits, living conditions, living environment, nutritional status, medical conditions and other factors.
5. How does trachoma evolve?
Chlamydia trachomatis only invades the epithelial cells of the lid conjunctiva and the conjunctiva of the fornix, but the pathological changes caused reach the deep tissues. The incubation period is about 5 to 2 days, usually invades both eyes, and the patient has a foreign body sensation, photophobia, tearing, and a lot of mucus or mucoid discharge. Trachomatous inflammation is located in the lid conjunctiva and begins to be seen as small, slightly whitish, dot-like changes, 0.2 to 2 mm in size, called follicles. Sometimes reddish dotted damage (papillae) is also seen. In the presence of severe inflammation, the blood vessels are blurred due to thickening of the conjunctival edema, and in more severe cases, the cornea may be invaded and corneal vascular opacities may occur. The acute symptoms of lid conjunctival congestion, edema, roughness, and papillary hypertrophy and hyperplasia subside after a few weeks and enter the chronic phase, when there may be no discomfort or only a feeling that the eye is easily fatigued. If cured or self-healing at this time, can not leave a scar. In other words, the primary infection of trachoma can heal without scarring. However, in endemic areas with poor sanitary conditions, repeated infections are common. The primary infection has sensitized the conjunctival tissues to Chlamydia trachomatis, and when Chlamydia trachomatis is encountered again, it causes a delayed hypersensitivity reaction. Trachoma often has progressive episodes during the chronic course of the disease, which may be a manifestation of repeated infections. After many repeated infections, aggravation of the original trachoma vascular opacities and scar formation, late due to the occurrence of severe scarring of the affected lid conjunctiva, so that the eyelashes inverted inward growth, that is, the formation of inverted eyelashes. The inverted eyelashes rub against the cornea, causing corneal damage and aggravating corneal turbidity, and the eyelashes continue to rub against the cornea causing white scarring, which can lead to vision loss and even blindness. In addition to repeated infections, the combination of other bacterial infections also aggravates the condition.
6. What are the sequelae of trachoma?
The following sequelae and complications often occur in severe trachoma:
①Trachomatous ptosis: it can be seen in the early stage of trachoma infection, and the weakness of the upper eyelid lifting is sleepy. In the early stage is trachoma caused by infiltration, congestion, edema and the weight of the upper eyelid increased and Miller's muscle is violated. In the late stage, the Miller's muscle is destroyed, scar formation, loss of contraction ability and permanent ptosis.
2 eyelid inversion: extremely common, due to conjunctival scar contraction and lid curvature deformity, so that the eyelid margins turned inward, resulting in eyelashes inverted to the corneal side of the growth of the inverted eyelashes, which irritate the cornea and cause discomfort.
3 corneal clouding: cornea is commonly known as the black eye, severe corneal vascular cataract and eyelid inversion inverted eyelashes rubbing the cornea so that corneal ulceration, corneal clouding white, vision loss.
4 lid and ball adhesion: the fornix is shortened due to conjunctival scar contraction, or even completely disappeared, especially the lower part of the fornix is notable, when traction on the lower lid in the eyelid and the conjunctiva between the eyeball can be seen in the vertical folds, that is, this sign.
⑤ Substantial conjunctival dryness: due to extensive conjunctival scarring, the cup cells and paralacrimal secretory function is destroyed, the lacrimal duct is occluded, so that the conjunctiva can not be wet, and gradually dry, keratinization of the corneal epithelium occurs, which is manifested as dryness, prickling, and other discomforts.
6 chronic dacryocystitis: trachoma lesions involving the mucosa of the lacrimal duct, the nasolacrimal duct stenosis or obstruction, resulting in chronic dacryocystitis, manifested as tearing, pus or squeezing the root of the nose with a large amount of pus overflow.
7, trachoma blindness is how to cause?
Trachoma is the second most common blinding eye disease in the world after cataract. The cause of trachoma blindness is due to trachoma damage to the cornea. Because, mild corneal vascular opacities can still degenerate with treatment, but severe vascular opacities whose blood vessel walls have hardened will leave scar tissue that remains constant after treatment. Inverted eyelashes irritate the corneal epithelium, causing superficial punctate keratitis and diffuse punctate keratitis, leading to neovascularization of the corneal surface. Decreased tear production causes the cornea to lose its luster and subsequently become gray and cloudy, with corneal epithelial keratinization and a skin-like appearance. Secondary bacterial infections following the formation of trachomatous corneal ulcers can cause corneal perforation and atrophy of the eye. All of the above may cause severe visual impairment leading to blindness.
8. Does trachoma always lead to blindness?
Trachoma is easily infected on the one hand, and on the other hand, due to the environment, personal hygiene habits can lead to recurrent infections, making trachoma more and more intense, eye health is deteriorating, downhill along the slope, and ultimately sliding straight to the bottom of the slope and blindness; which recurrent infections is a necessary condition of blindness of trachoma, such as has been infected with trachoma, the treatment and prevention is very important, at every stage of the prevention and control, to stop its development and to make people away from the harm of blindness.
9. How can trachoma be prevented?
Trachoma prevention is an important public **** health problems, and because Chlamydia trachomatis is often attached to the patient's eye secretions, any contact with this secretion can be caused by trachoma transmission of the opportunity to infect, therefore, to strengthen health education and publicity, popularize knowledge of hygiene, and cultivate good hygiene habits, to keep the face clean, do not use hands to rub the eyes, handkerchiefs, hand towels, handkerchiefs, to be washed regularly, sun-drying; nursery , schools, factories and other collective units of the sleeping area should be separated and ventilated, should be divided into basins and towels or running water to wash the face, strengthen the barber room, bathrooms, hotels and other service industries, strict disinfection of towels, basins and other disinfecting system; reasonable disposal of garbage, improve the environment of the toilet, reduce or eliminate the flies, and pay attention to the cleanliness of the water source, in order to block the way of transmission of trachoma, to reduce the transmission of the infection, to prevent the prevalence of infection of trachoma.
10. What are the medications for trachoma? How to treat and control trachoma with drugs?
Antimicrobials are quite important in the treatment of active trachoma infections in the population. Since the early 1950s, the treatment of trachoma has relied mainly on the long-term topical use of tetracycline. Chlamydia trachomatis is sensitive to a number of antibiotics including sulfonamides, erythromycin, and tetracycline. Tetracycline ophthalmic ointment was widely used because of its low cost and reliable results. Tetracycline is effective in reducing the prevalence and severity of inflammatory trachoma in the short term, but this treatment is considered suppressive rather than curative, and long-term use is needed to enhance its efficacy.1% tetracycline eye ointment twice daily*** for 6 months. Or intermittent treatment, 2x/day for 5 days/month. or 1/day/month for 10 consecutive days/month for a minimum of 6 months/year of continuous use. Individual topical tetracycline use will result in the disappearance of Chlamydia trachomatis infections and a reduction in secondary bacterial infections. This would be a short-term reduction in existing and severe ocular infections, whereas extraocular chlamydial infections are not affected, and the eye would undergo its own reinfection. In addition, if not all infected individuals in an antibiotic-treated community are effectively treated, transmission of chlamydia can restart. Group and home treatment should be used for endemic areas, i.e., topical antibiotic therapy for groups or individuals/families of patients with active trachoma, and additional systemic antibiotic therapy for severe patients, initially using sulfonamide but later replaced by tetracycline, hygromycin, or doxycycline. Oral tetracycline: 250mg 4 times daily for 3 weeks ****. or doxycycline 100mg once daily for ***3 weeks. For children or pregnant women erythromycin 250 mg 4 times daily for ****3 weeks is recommended. Recent studies in The Gambia, Egypt, and Saudi Arabia have shown that a single oral dose of 1 g of azithromycin in adults has good efficacy in the treatment of Chlamydia trachomatis; however, the high price of azithromycin is a concern.
11. How do you treat impaction?
There are a variety of possible measures to treat impaction, including the following:
1. Eyelash removal: this is a simple and inexpensive method, and it is an effective treatment if impaction surgery is not possible for some reason.
2. Electrolysis of the hair follicle: this is a relatively simple method but requires proper equipment, and a report of a 2-year follow-up indicated a success rate of about 25% for mild impaction.
3. Cryo-extraction of eyelashes: like follicular electrolysis, requires appropriate equipment and learning to apply the technique of freezing, which causes depigmentation of the eyelid skin, with a success rate similar to that of follicular electrolysis.
4. Inverted eyelash surgery: Surgical correction of inverted eyelashes is the "last chance" to prevent trachomatous blindness and is the most urgent action to be taken. There are many different surgical procedures to correct inverted eyelashes, but one procedure, called double lid rotation, is easy to perform and has a high success rate of correction.
Based on the above information, the best treatment for inverted eyelashes is surgery. Eyelash removal is only effective for a short period of time, and electrolysis of the follicle and cryo-extraction have a relatively low success rate.
12. How can trachoma be controlled?
The World Health Organization (WHO) has put forward four elements for effective trachoma control, namely SAFE strategy, which consists of four English words, S=Surgery, A=Antibiotics, F=Facial Cleanliness, E=Environmental improvements. Improvements improve the environment.
Surgery to correct trachoma inverted eyelashes: The use of double-layer lid rotational inversion correction to turn the inverted eyelashes that rub against the cornea outward can prevent the eyelashes from rubbing against the cornea and causing further loss of vision, which is the "last chance" to prevent trachoma blindness effectively and is the most urgently needed action to be taken.
A Antimicrobial treatment for people with active trachoma infection: Regular checkups and treatment of patients with active trachoma are important, and 1% tetracycline eye ointment is applied to the eye twice daily for six weeks in cases of active trachoma.
F Washing face and cleaning eyes: Increasing the frequency of face washing to keep the face clean can effectively prevent and control trachoma, and at the same time, attention should be paid to towels and washbasins for exclusive use to prevent trachoma microorganisms from spreading to each other.
E Improvement of the environment (water and sanitation) to eliminate trachoma: Improvement of the water supply, sanitation, and the living environment (including disposal of garbage, elimination of flies, and segregation and ventilation of the sleeping area) can prevent trachoma, which is the most arduous task in controlling trachoma that needs to be carried out over a long period of time.