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- Causes of blindness
Trachoma (a repeated conjunctivitis infection) is found worldwide. Though eradicated in most developed countries, it remains a significant public health problem in parts of the developing world. It is closely linked to poverty.
The facts about trachoma:
- The World Health Organization estimates that trachoma affects about 84 million people
- 8 million of these are visually impaired
- Trachoma is the second most common cause of blindness after cataract.
Where is it found?
Trachoma is found in hot and dusty parts of the world. It is often endemic in rural areas without basic sanitation, where washing hands and faces is difficult. Trachoma spreads rapidly in crowded households or neighbourhoods.
Children and trachoma
Demographically, active trachoma is most prevalent in children, although the scarring doesn't usually become visible until the early 20s. For those who have suffered since childhood, trichiasis normally sets in during their 40s - or even earlier in the worst-affected areas.
Women and trachoma
Women are much more susceptible to trachoma than men because they spend far more time in contact with children, providing childcare.
Causes of trachoma
Trachoma is linked to extreme poverty and poor sanitation. It is triggered by bacteria that cause repeated conjunctivitis, irritating the eyes and creating a mucous discharge. Although the conjunctivitis clears up after a month or so, it is easily spread. This is particularly the case in places where there is little water for people to wash their hands and faces regularly.
How trachoma causes corneal damage:
- reducing the amount of tears produced
- making it difficult to close the eyelids (which lubricate the eye and help flush away dust and dirt)
- triggering trichiasis, where the eyelid and eyelashes turn in on the eye.
How does it spread?
- The discharge from infected eyes attracts flies that then land on other people's skin. People in crowded households or neighbourhoods are particularly vulnerable.
- Each infection of trachoma leads to a small amount of scarring on the cornea and conjunctiva. This scarring builds up over years of repeated infection until trichiasis sets in.
Trichiasis is when this scarring causes the eyelid to turn inwards, making eyelashes scratch the eyeball. Each time the eyelashes are lowered to blink, the cornea - which enables the eye to focus - is put at risk. Eventually it becomes opaque, causing poor vision and eventual irreversible blindness.
People often try to pull out the eyelashes themselves, put powder on their eyelids, or use tight headscarves to pull up the skin around the eye to restrict blinking. None of these provides a long-term solution.
Sightsavers is part of the Global Elimination of Trachoma by 2020 programme, working alongside the World Health Organization and other voluntary organisations.
Since its launch in 1998 the programme has treated more than seven million people and reduced active trachoma in children by 50 per cent.
Sightsavers follows the SAFE strategy for treating trachoma. (Surgery, Antibiotics, Facial cleanliness and Environmental hygiene).
Sightsavers trains nurses to perform surgery for trichiasis in their community. The surgery can be done at a local health clinic or even in the home, meaning that people do not have to travel huge distances to seek treatment. The operation involves removing the parts of the eyelid which are being pulled inwards, causing the lashes to touch the eye, so the eyelids turn back out again. This
- Stops the trichiasis from getting worse
- Improves vision in the short term
- Makes it much more comfortable for people
- Reduces the levels of eye discharge
Sightsavers provides two types of antibiotic to treat trachoma:
- Tetracycline - ointment applied directly to the eye over a period of six weeks. Done properly, it has a success rate of 60-80%.
- Oral azithromycin - this is just as medically effective as tetracycline, but because it is taken orally it is far more successful.
Problems with antibiotics:
- Antibiotics have side effects
- Overuse can make people immune to them. For this reason they should only be part of trachoma treatment, used with Infection-reduction methods such as facial cleanliness and good sanitation.
- Treatment takes a long time and is difficult to administer in rural areas.
Children with dirty faces may be up to two times more likely to contract the trachoma virus than those without. One of the best ways to prevent the transmission of trachoma is by encouraging face and hand washing - not easy where water is scarce.
Sightsavers' local partners are encouraging facial cleanliness through:
- Training health workers to conduct health promotion sessions in local communities, explaining the benefits of face and hand washing
- Promoting the use of the 'leaky tin', a cheap and easy method of face and hand washing where water is scarce
- Improving access to water
- Improving availability of soap
The transmission of trachoma by flies can be tackled by reducing the number of flies people come into contact with. Sightsavers' local partners helps communities to achieve this by setting up local sanitation committees to:
- Build covered latrines and encourage facial cleanliness
- Discourage people from sleeping close to their livestock, a common practice in Africa and Asia.
- Encourage villagers to collect and burn rubbish on a regular basis