eMedicine Specialties > Ophthalmology > Infectious Disease

Trachoma: Follow-up

Author: Anthony W Solomon, MBBS, DTM&H, PhD, MRCP, Specialist Registrar in Infectious Diseases, Lister Unit, Northwick Park Hospital, London; Honorary Lecturer, International Centre for Eye Health, Clinical Research Unit, London School of Hygiene and Tropical Medicine, London
Coauthor(s): Hugh Ringland Taylor AC, MD, MBBS, BmedSc (Melb), DO (Melb), FRACO, FRACS, FAAO, FACS, FAICD, Harold Mitchell Professor of Indigenous Eye Health, School of Population Health, University of Melbourne
Contributor Information and Disclosures

Updated: Sep 5, 2007

Follow-up

Further Outpatient Care

  • Long-term, intermittent follow-up care is required for patients with active or cicatricial disease.
  • One episode of infection may be treated adequately, but reinfection from the community pool of infection is likely unless an effective mass treatment campaign is implemented. When mass treatment is undertaken, antibiotic coverage should be as high as possible, with 80% being an absolute minimal target.  It is important to treat all family members, especially the younger children.
  • Some studies suggest a great benefit if coverage in excess of 95% can be achieved.
  • Surgical patients require annual follow-up care because of the potential for recurrence.

Deterrence/Prevention

  • Facial cleanliness and environmental improvement are major components of the SAFE strategy.
  • Many regard the lack of facial cleanliness in children as the key factor for the persistence of trachoma.

Prognosis

  • The prognosis depends on the severity of the disease at the time of treatment, the appropriateness of the treatment, and the risk of reinfection.
  • Patients in whom early disease is treated appropriately have an excellent prognosis.
  • Severe disease may be stabilized, but the patient's vision may not improve once corneal scarring has developed.
  • Reinfection worsens the prognosis.

Miscellaneous

Medicolegal Pitfalls

  • Emphasize to patients that their entire families require assessment and treatment.
  • Although appropriate treatment is curative, aggressive steps may be required to prevent reinfection.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Denise Mabey, FRCOphth, MBBS, to the development and writing of this article.



More on Trachoma

Overview: Trachoma
Differential Diagnoses & Workup: Trachoma
Treatment & Medication: Trachoma
Follow-up: Trachoma
Multimedia: Trachoma
References
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References

  1. Bobo LD, Novak N, Munoz B, Hsieh YH, Quinn TC, West S. Severe disease in children with trachoma is associated with persistent Chlamydia trachomatis infection. J Infect Dis. Dec 1997;176(6):1524-30. [Medline].

  2. Dawson CR, Schachter J, Sallam S, Sheta A, Rubinstein RA, Washton H. A comparison of oral azithromycin with topical oxytetracycline/polymyxin for the treatment of trachoma in children. Clin Infect Dis. Mar 1997;24(3):363-8. [Medline].

  3. Grayston JT, Wang SP, Yeh LJ, Kuo CC. Importance of reinfection in the pathogenesis of trachoma. Rev Infect Dis. Nov-Dec 1985;7(6):717-25. [Medline].

  4. Mabey DC, Solomon AW, Foster A. Trachoma. Lancet. Jul 19 2003;362(9379):223-9. [Medline].

  5. Reacher M, Foster A, Huber J. Trichiasis surgery for trachoma: the bilamellar tarsal rotation procedure. WHO/PBL 93.29. Geneva: World Health Organization;. 1993.

  6. Solomon A, Burton M. What's new in azithromyin?. Community Eye Health. Dec 2004;17(52):54-6. [Medline].

  7. Taylor HR, Johnson SL, Schachter J, Caldwell HD, Prendergast RA. Pathogenesis of trachoma: the stimulus for inflammation. J Immunol. May 1 1987;138(9):3023-7. [Medline].

  8. Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR. A simple system for the assessment of trachoma and its complications. Bull World Health Organ. 1987;65(4):477-83. [Medline].

  9. West S, Munoz B, Lynch M, Kayongoya A, Chilangwa Z, Mmbaga BB, et al. Impact of face-washing on trachoma in Kongwa, Tanzania. Lancet. Jan 21 1995;345(8943):155-8. [Medline].

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Further Reading

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Keywords

Chlamydia trachomatis, C trachomatis, chronic keratoconjunctivitis, SAFE strategy for trachoma, trichiasis, simplified trachoma grading scheme, trachomatous scarring, corneal opacity

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Contributor Information and Disclosures

Author

Anthony W Solomon, MBBS, DTM&H, PhD, MRCP, Specialist Registrar in Infectious Diseases, Lister Unit, Northwick Park Hospital, London; Honorary Lecturer, International Centre for Eye Health, Clinical Research Unit, London School of Hygiene and Tropical Medicine, London
Anthony W Solomon, MBBS, DTM&H, PhD, MRCP is a member of the following medical societies: Royal College of Physicians of the United Kingdom
Disclosure: Pfizer Inc Grant/research funds Researcher; International Trachoma Initiative Grant/research funds Researcher; Pfizer Inc Support to attend the Trachoma Scientific Exchange in Phoenix, 2006 Review panel membership

Coauthor(s)

Hugh Ringland Taylor AC, MD, MBBS, BmedSc (Melb), DO (Melb), FRACO, FRACS, FAAO, FACS, FAICD, Harold Mitchell Professor of Indigenous Eye Health, School of Population Health, University of Melbourne
Hugh Ringland Taylor AC, MD, MBBS, BmedSc (Melb), DO (Melb), FRACO, FRACS, FAAO, FACS, FAICD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Anastasios J Kanellopoulos, MD, Assistant Program Director, Clinical Associate Professor, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York University
Anastasios J Kanellopoulos, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Eye Bank Association of America, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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