Trachoma: Symptoms and Treatment


Trachoma — is a chronic infectious disease that affects the eyes. The main and only causative agent of the disease is a bacterium from the Chlamydia family. The disease belongs to an infectious group, which can be transmitted from person to person. It affects people regardless of age and sex, which is often diagnosed in children.

The clinical picture in the early stages of the disease can go unnoticed, it is rare that such a disorder manifests itself in an acute form. The first symptoms can be redness of the eyes, photophobia and increased tearing. In the course of the development of the disease, scar tissue is formed.

Diagnosis of the disease is based on a wide range of laboratory studies that are aimed at detecting the causative agent of trachoma. Treatment consists of the use of medications and surgical procedures.

The danger of the disease lies in the fact that it progresses rather quickly and without the timely elimination can lead to the appearance of irreversible complications, in particular, to complete loss of vision.

Etiology

The main causative agent of trachoma is a bacterium from the family of chlamydia, which parasitizes inside the cells of the human body. The main way of transmission of infection is contact-household. Those. The factor of occurrence is the transfer of the infected separated from the mucous patient to a healthy person. In addition, the infectious process can be spread with the help of personal hygiene items, the pathogenic microorganism can penetrate into the conjunctival bag with contaminated hands.

The sources of transmission of the bacteria can serve as people with the course of the active form of the infectious process, as well as carriers with an atypical or erased course of this disorder.

Experts do not refute the probability of mechanical transfer of a pathological microorganism, for example, by insects, in particular flies. Also, the main role in the formation of the disease is played by unsatisfactory living or working conditions, as well as low level of sanitary literacy of the population.

The most active course of trachoma is observed in children aged from four to ten years. The greatest likelihood of complications of this disorder is observed in people over 50 years of age. Specialists from the field of ophthalmology noted that several times more often the disease occurs in women.

Another characteristic feature of the disease is that even if it was cured, then the organism does not develop immunity against this pathogen, which makes it likely that the disease will reappear.

Classification

As the infectious process develops, trachoma in children and adults undergoes several stages of development:


  • initial — at this stage there is a pronounced infectious process, against which the swelling develops and changes in the structure of the conjunctiva occur — it becomes friable. To detect the disease at this stage is possible only with the help of an ophthalmologic examination;
  • Medium — the occurrence of follicular nodules, which gradually increase in size. In addition, the connection of several small nodules to one large one is coming. At the same time, some of them may collapse, against which the formation of scar tissue occurs. It is at this stage of the course that patients are most contagious;
  • of moderate severity — the inflammatory process stops, the scarring comes first,
  • severe — complete inflammation with complete scarring is observed.

In addition, several forms of the trachoma of the eye are divided:


  1. follicular — at which small bubbles or nodules form;
  2. papillary — differs in that papillary growths are observed;
  3. mixed — there are signs of the two above forms
  4. infiltrative trachoma.

Symptoms

Trachoma disease often spreads to both eyes. However, in the first stage of formation one eye is affected, and a second is involved in a week. From the time of infection with chlamydia until the appearance of the first symptomatology on average runs from ten to fourteen days. At the first stages of development, in addition to inflammation, which is expressed in the redness and swelling of the conjunctiva, no other signs of the disease are observed.

But as the disease develops, the following symptoms of trachoma occur:






  • profuse tear
  • development of photophobia
  • The sensation of sand in the eyes
  • change in the hue of not only the conjunctiva, but also the skin of the eyelids
  • severe swelling
  • reddening of the protein coat;
  • the appearance of small papillae or nodules;
  • follicle breakdown and scar appearance
  • fusion of nodules, which is expressed in an increase in the volume and density of the tissue
  • gradual reduction of visual acuity.

To aggravate the course of the disease in a child or adult patient may have the presence of concomitant ailments such as tuberculosis, scrofulosis, helminth infection, malaria, etc. In addition, an aggravating factor may be the attachment of conjunctivitis of a bacterial or viral nature. In cases of development of a secondary infectious process, complications of trachoma occur.

Diagnostics

Laboratory tests and examinations of a specialist have diagnostic value when establishing the correct diagnosis. Thus, the diagnosis of trachoma includes:


  1. A thorough examination from an ophthalmologist, which is carried out with the help of special tools. It is aimed at identifying a variety of disease and identifying the stage of trachoma, which plays a very important role in the appointment of the tactics of treatment of the disease;
  2. performing scraping with conjunctiva — for subsequent histological and cytological studies. This will provide an opportunity to clarify the cause of trachoma;
  3. implementation of specific assays for the detection of the pathogen antigen
  4. detection of the pathogen by the PCR technique, which is based on excretion of DNA particles of a pathogenic bacterium
  5. detection of antibodies to the pathogen in the blood.

Treatment

The tactics for eliminating the disease depend on the stage of the diagnosis. For example, the therapy of the ailment of the fourth and third stage is carried out in a hospital environment, and at the first and second — the follicle is eliminated with tweezers.

Regardless of the stage of the disease, patients are prescribed antibiotics and sulfonamides, which can be used as ointments inserted into the conjunctival sac or administered intravenously.

The expression «follicle» refers to the surgical technique — it is an alternative to squeezing nodules with tweezers. This procedure makes it possible to significantly reduce the duration of treatment of trachoma. If necessary, repeated extrusions are carried out with an interval of fifteen days.

Also, medical intervention is indicated in the development of complications of the disease. This includes such procedures as:


  • plastic surgery to correct eyelid twist. If necessary, a mucosal graft is transplanted from the oral cavity shell;
  • implantation of the parotid duct of the salivary gland — for moistening the surface of the eye

In the chronic form of the disease, resort to dacryocystorhinostomy.

Complications

If you ignore the symptoms and untimely started therapy, there is a possibility of complications such as:


  1. the formation of the pannus, which is a cloudy film that spreads throughout the cornea, while the mucosa is scarring
  2. impaired lash growth, i.e., they are directed towards the eyeball
  3. complete cessation of eyelash growth
  4. joining a secondary infectious process
  5. the appearance of a purulent corneal ulcer
  6. turning the eyelids into the eyeball
  7. complete blindness.

Timely elimination of the disease is the main factor of a favorable prognosis. Approximately 80% of patients completely recover after three months of complex therapy. At the very last stage of the development of the disease, there is a possibility of a recurrence of the disease in the interval from five to twenty years.

Specific prevention of trachoma does not exist. Adults and children only need to follow the rules of personal hygiene, minimize communication and contact with an infected person.