Trachoma

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Classification according to ICD-10
A71 Trachoma
ICD-10 online (WHO version 2019)
Entropion and trichiasis secondary to trachoma A44-652-11.jpg

A trachoma ( gr. : Τράχωμα, "Rough eye"), and conjunctivitis (granulosa) trachomatosa , Egyptian grain disease , Egyptian ophthalmia or trachomatous inclusion conjunctivitis called, is a bacterial infection of the eye with Chlamydia trachomatis (serotype A to C) associated with blindness can end.

Frequency and cause

Trachoma is very rare in industrialized countries, but it is the most common eye disease in tropical (developing) countries with poor hygienic conditions. About 500 million people suffer from it, and about six million are blind as a result. The disease is caused by an infection with Chlamydia trachomatis (serotypes A, B and C) through direct contact between the mucous membranes of the eyes, nose and mouth. It can be transmitted by sharing washcloths or towels, or by flying.

Symptoms

Most of those affected develop trachoma in early childhood. The disease is divided into four stages. After an incubation period of five to twelve days, the symptoms of bilateral conjunctivitis with a foreign body sensation, watery eyes and discharge of serous secretion from the eye appear as the first stage .

In the second stage, the conjunctiva of the upper eyelid shows yellow-white, slightly raised lymph follicles that are not supplied with blood vessels . These lymph follicles make the surface of the conjunctiva of the upper eyelid appear rough, which is where the name trachoma comes from. In addition, these inflammatory changes cause the upper eyelid to swell, become heavier and, as a result, droop. It is spoken of a ptosis trachomatosa. In addition, blood vessels of the conjunctiva on the upper edge of the cornea can sprout into the cornea, which normally does not have its own blood vessels, and form a so-called pannus trachomatosus .

In the third stage, the lymph follicles on the conjunctiva of the upper eyelid melt and burst. In their place there are now scars. In the fourth stage, the scars created in the third stage contract on the conjunctiva of the upper eyelid. As a result, they pull the edge of the upper eyelid with its eyelashes inwards towards the eyeball, creating a so-called scar entropion . Now the eyelashes rub against the cornea of ​​the eye with every blink and eye movement. It is spoken of a trichiasis . This constant rubbing causes injuries to the cornea which become infected and heal to form scars. The more scars there are on the cornea, the greater the impairment of vision. Without treatment, those affected go blind.

Diagnosis and therapy

The diagnosis of trachoma is based on the symptoms. Local or systemic antibiotics (only intracellular antibiotics, e.g. macrolides or tetracyclines ) are used to treat the infection . The current drug of first choice for monotherapy is sulfamethoxazole . If an eyelid malposition has already occurred, the position of the upper eyelid must be normalized by means of an operation. If the cornea is already severely scarred and vision is clearly restricted, a keratoplasty with replacement of the cornea can be performed.

In countries with poor medical care, sufferers pluck their eyelashes to prevent them from rubbing on the cornea.

Differential diagnosis

prophylaxis

In particular, an improvement in the hygienic and socio-economic living conditions together with an adequate supply of drinking water would help reduce the frequency of the disease.

forecast

The prognosis depends on the stage of the disease. If treatment is started in the early stages, the prognosis is good. Blindness occurs especially when the disease has not been treated for years and renewed infections occur frequently.

Global Program for the Elimination of Trachoma

Therapy and prophylaxis of trachoma are summarized in the SAFE strategy of the WHO Global Program for the Elimination of Trachoma :

Reporting requirement

In Austria, trachoma is a notifiable disease in accordance with Section 1 (1) of the 1950 Epidemic Act . The obligation to notify relates to cases of illness and death. Doctors and laboratories, among others, are obliged to report this ( Section 3 Epidemics Act).

See also

Other diseases caused by Chlamydia trachomatis are the widespread but clearly underestimated (oculo-) genital chlamydial infection (main cause of fallopian tube-related sterility in women), which is caused by serotypes DK, as well as lymphogranuloma venereum (lymphogranuloma ) caused by serotypes L1-L3 inguinale).

swell

  • Joseph A. Cook: Eliminating Blinding Trachoma . In: N Engl J Med . No. 358 , 2008, p. 1777-1779 ( abstract ).
  • Klaus Jacob: Transverse tarsotomy in the trachomatous entropion of the upper eyelid. In: Clin. Monthly sheets for ophthalmology. Volume 153, Issue 6, Enke Verlag, Stuttgart 1968.

Individual evidence

  1. Every blink hurts, friend's letter of the christoffel blind mission August 2020

literature

  • M. Sachsenweger: Ophthalmology . (= Dual row). 2nd Edition. Georg Thieme Verlag, Stuttgart 2003, ISBN 3-13-128312-2 , pp. 81-83.