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Trachoma — Clinical Guidelines

Overview

Trachoma is a chronic infectious disease caused by Chlamydia trachomatis that leads to conjunctival inflammation, potentially progressing to entropion, trichiasis, corneal scarring, and blindness 1 4 6.

Diagnosis

Clinical Presentation: Inflammation of the conjunctiva, follicular conjunctivitis (Stage 1), intense conjunctival inflammation with papillae (Stage 2), cicatricial trachoma with entropion and trichiasis (Stage 3), and cicatrization leading to corneal opacification (Stage 4) 4.

Grading: Utilizes the 'MacCallan Classification' adopted by WHO, standardizing stages from follicular to irreversible blindness 4.

Epidemiological Assessment: Rapid assessments in endemic regions, examining children aged 1-9 years for active trachoma and adults for trichiasis 6.

Management

Antibiotic Treatment: Azithromycin mass drug administration (MDA) is effective, with quarterly MDA potentially reducing child mortality and decreasing general morbidity including respiratory tract infections, diarrhea, fever, vomiting, and headache 2.

Surgical Interventions: Eyelid surgery for trichiasis to prevent corneal scarring and blindness 6.

Preventive Measures: Facial cleanliness and environmental improvements to reduce transmission 6.

Special Populations

Pediatrics: Azithromycin MDA shows benefits in reducing child mortality and general morbidity 2.

Elderly: Specific management strategies not detailed in abstracts; focus remains on surgical correction for trichiasis and preventive hygiene measures 6.

Key Recommendations

Implement azithromycin mass drug administration (MDA) quarterly to reduce trachoma-related morbidity and child mortality (Evidence: Strong 2).

Utilize the 'MacCallan Classification' for standardized staging and monitoring of trachoma progression (Evidence: Strong 4).

Prioritize surgical correction for trichiasis in affected populations to prevent corneal blindness (Evidence: Moderate 6).

Enhance community education on facial cleanliness and environmental hygiene to control trachoma transmission (Evidence: Expert opinion 6 8).

References

1 Üstün Ç, Özçiftçi S. An ophthalmologist fought against trachoma in Turkey and his books from an archive: Dr Nuri Fehmi Ayberk and The Development of Ophthalmology in Turkey. Journal of medical biography 2024. link 2 Li J, Xiong T, Yue Y, Choonara I, Qazi S, Tang J et al.. Secondary Effects from Mass Azithromycin Administration: A Systematic Review and Meta-analysis. The American journal of tropical medicine and hygiene 2022. link 3 Bohigian GM, Feibel RM. Francis I. Proctor, MD and his wife Elizabeth C. Proctor: Their lives and legacy. Journal of medical biography 2020. link 4 MacCallan M. Arthur Ferguson MacCallan CBE, MD, FRCS (1872-1955), trachoma pioneer and the ophthalmic campaign in Egypt 1903-1923. Journal of medical biography 2018. link 5 Feibel RM. Vincent (Censu) Tabone, an ophthalmologist and a president of the Republic of Malta. Archives of ophthalmology (Chicago, Ill. : 1960) 2012. link 6 Al-Khatib TK, Hamid AS, Al-Kuhlany AM, Al-Jabal MH, Raja'a YA. Rapid assessment of trachoma in 9 governorates and Socotra Island in Yemen. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit 2006. link 7 McManus M. Mobile eye units in the fight against eye disease in East Africa. Journal of ophthalmic nursing & technology 1993. link 8 Tamblyn DM. Aboriginal eye problems. Australian family physician 1984. link 9 Becker Y, Asher Y. Obligate parasitism of trachoma agent: lack of trachoma development in ethidium bromide-treated cells. Antimicrobial agents and chemotherapy 1972. link

Trachoma