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Trachoma Follow-up

  • Author: Hugh Ringland Taylor, AC, MD, MBBS, BMedSc(Melb), DO(Melb), FRANZCO, FRACS, FAAO, FACS, FAICD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Aug 10, 2015
 

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.

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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.

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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.

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Contributor Information and Disclosures
Author

Hugh Ringland Taylor, AC, MD, MBBS, BMedSc(Melb), DO(Melb), FRANZCO, FRACS, FAAO, FACS, FAICD Harold Mitchell Professor of Indigenous Eye Health, Melbourne School of Population and Global Health, University of Melbourne

Hugh Ringland Taylor, AC, MD, MBBS, BMedSc(Melb), DO(Melb), FRANZCO, FRACS, FAAO, FACS, FAICD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Anthony W Solomon, MBBS, DTM&H, PhD, MRCP Wellcome Trust Intermediate Clinical Fellow, Senior Lecturer, Department of Clinical Research, London School of Hygiene and Tropical Medicine; Honorary Consultant Physician, The Hospital for Tropical Diseases, UK

Anthony W Solomon, MBBS, DTM&H, PhD, MRCP is a member of the following medical societies: American Society of Tropical Medicine and Hygiene, Royal College of Physicians, Royal Society of Tropical Medicine and Hygiene

Disclosure: Received grant/research funds from International Trachoma Initiative for researcher; Received member of trachoma expert committee from International Trachoma Initiative for review panel membership; Received member of scientific advisory board from Queen Elizabeth Diamond Jubilee Trust for review panel membership.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

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.

Denise Mabey, FRCOphth, MBBS Consulting Staff, Department of Ophthalmology, St Thomas Hospital of London

Disclosure: Nothing to disclose.

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. 1997 Dec. 176(6):1524-30. [Medline].

  2. 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]. [Full Text].

  3. West SK, Munoz BE, Mkocha H, Gaydos C, Quinn T. Risk of Infection with Chlamydia trachomatis from Migrants to Communities Undergoing Mass Drug Administration for Trachoma Control. Ophthalmic Epidemiol. 2015 Jun. 22 (3):170-5. [Medline].

  4. Kalua K, Chirwa T, Kalilani L, Abbenyi S, Mukaka M, Bailey R. Prevalence and risk factors for trachoma in central and southern Malawi. PLoS One. 2010 Feb 5. 5(2):e9067. [Medline]. [Full Text].

  5. Baker MC, Mathieu E, Fleming FM, et al. Mapping, monitoring, and surveillance of neglected tropical diseases: towards a policy framework. Lancet. 2010 Jan 16. 375(9710):231-8. [Medline].

  6. Solomon AW, Pavluck AL, Courtright P, Aboe A, et al. The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study. Ophthalmic Epidemiol. 2015 Jun. 22 (3):214-25. [Medline].

  7. Katibeh M, Hosseini S, Yaseri M, Aminifar MN, Mahdavi A, Jafarinasab MR, et al. Prevalence and Risk Factors for Trachoma in Rural Areas of Sistan-va-Baluchestan Province, Iran: A Population-Based Study. Ophthalmic Epidemiol. 2015 Jun. 22 (3):208-13. [Medline].

  8. Ramyil A, Wade P, Ogoshi C, Goyol M, Adenuga O, Dami N, et al. Prevalence of Trachoma in Jigawa State, Northwestern Nigeria. Ophthalmic Epidemiol. 2015 Jun. 22 (3):184-9. [Medline].

  9. Evans JR, Solomon AW. Antibiotics for trachoma. Cochrane Database Syst Rev. 2011 Mar 16. CD001860. [Medline].

  10. West S, Munoz B, Lynch M, et al. Impact of face-washing on trachoma in Kongwa, Tanzania. Lancet. 1995 Jan 21. 345(8943):155-8. [Medline].

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

  12. 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. 1997 Mar. 24(3):363-8. [Medline].

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

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

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

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

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Trachomatous inflammation, follicular (TF), is the presence of 5 or more follicles (each at least 0.5 mm in diameter) on the central part of the upper tarsal conjunctiva. Images from the Slides/Text Teaching Series, No. 7, Trachoma, published by The International Centre for Eye Health, Institute of Ophthalmology, 11-43 Bath St, London EC1V 9EL, United Kingdom. Photograph courtesy of John D. C. Anderson, MD.
Trachomatous inflammation, intense (TI) is pronounced inflammatory thickening of the upper tarsal conjunctiva that obscures more than one half the normal deep tarsal vessels. Photograph courtesy of Allen Foster, MD.
Trachomatous conjunctival scarring (TS) is the presence of easily visible scars in the tarsal conjunctiva.
Trachomatous trichiasis (TT) is defined as the presence of at least 1 eyelash rubbing on the eyeball or evidence of recent removal of in-turned lashes. Photograph courtesy of John D. C. Anderson, MD.
Easily visible corneal opacity over the pupil; it is so dense that at least part of the pupil margin is blurred when viewed through the opacity. Photograph courtesy of John D. C. Anderson, MD.
The image on the left shows intense inflammatory trachoma, and the image on the right shows allergic conjunctivitis with the typical cobblestone papillae. Courtesy of John D. C. Anderson, MD, and Murray McGavin, MD.
 
 
 
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