Trachoma Management

Management of trachoma should involve curative as
well as control measures.

A. Treatment of active trachoma
Antibiotics for treatment of active trachoma may be
given locally or systemically, but topical treatment is
preferred because:

• It is cheaper,
• There is no risk of systemic side-effects, and
• Local antibiotics are also effective against bacterial conjunctivitis which may be associated with trachoma.

The following topical and systemic therapy
regimes have been recommended:

1. Topical therapy regimes. It is best for individual
cases. It consists of 1 percent tetracycline or 1
percent erythromycin eye ointment 4 times a day
for 6 weeks or 20 percent sulfacetamide eye
drops three times a day along with 1 percent
tetracycline eye ointment at bed time for 6 weeks.
The continuous treatment for active trachoma
should be followed by an intermittent treatment
especially in endemic or hyperendemic area.

2. Systemic therapy regimes. Tetracycline or
erythromycin 250 mg orally, four times a day for
3-4 weeks or doxycycline 100 mg orally twice
daily for 3-4 weeks or single dose of 1 gm
azithromycin has also been reported to be equally
effective in treating trachoma.

3. Combined topical and systemic therapy regime.
It is preferred when the ocular infection is severe
(TI) or when there is associated genital infection.
It includes: (i) 1 per cent tetracycline or
erythromycin eye ointment 4 times a day for 6
weeks; and (ii) tetracycline or erythromycin 250
mg orally 4 times a day for 2 weeks.

B. Treatment of trachoma sequelae
1. Concretions should be removed with a hypodermic needle.
2. Trichiasis may be treated by epilation, electrolysis or cryolysis .
3. Entropion should be corrected surgically.
4. Xerosis should be treated by artificial tears.

C. Prophylaxis
Since, immunity is very poor and short lived, so
reinfections and recurrences are likely to occur.
Following prophylactic measures may be helpful
against reinfection of trachoma.

1. Hygienic measures. These help a great deal in
decreasing the transmission of disease, as
trachoma is closely associated with personal
hygiene and environmental sanitation. Therefore,
health education on trachoma should be given to
public. The use of common towel, handkerchief,
surma rods etc. should be discouraged. A good
environmental sanitation will reduce the flies. A
good water supply would improve washing habits.

2. Early treatment of conjunctivitis. Every case of
conjunctivitis should be treated as early as
possible to reduce transmission of disease.

3. Blanket antibiotic therapy (intermittent
treatment). WHO has recommended this regime
to be carried out in endemic areas to minimise the
intensity and severity of disease. The regime is
to apply 1 percent tetracycline eye ointment twice
daily for 5 days in a month for 6 months.

D. Prevention of trachoma blindness
Trachoma is a leading cause of preventable blindness
worldwide with an estimated 5.9 million persons blind
or at immediate risk because of trichiasis.10 The
disease accounts for nearly one-sixth of the global
burden of blindness. In India, blindness due to
trachoma (0.39%, WHO-NPCB 1986-89) is on the
decline when compared with previous figures (20%,
ICMR 1975).
Effective interventions have been demonstrated
in developing nations using the SAFE strategy:

• Surgery to correct lid deformity and prevent blindness,
• Antibiotics for acute infections and community control,
• Facial hygiene, and
• Environmental change including improved access to water and sanitation and health education.

Elimination of blindness due to trachoma is
considered feasible, eradication of trachoma is not.
Trachoma has disappeared from North America and
Europe because of improved socio-economic
conditions and hygiene. Research needs include
validation of rapid community assessment
techniques, identification of barriers to the
acceptance of preventive surgical procedure, studying
effectiveness of annual treatment cycles and costeffective
studies. W.H.O. has organized an Alliance
for Global Elimination of Trachoma by the year 2020
(GET 2020).