Healthcare and Medicine Reference
In-Depth Information
TRACHOMA
Treatment
With the goal of eliminating blinding trachoma by the year 2020, the Global
Alliance for the Elimination of Blinding Trachoma (GET2020) was formed in
1998, including the WHO, trachoma endemic countries and organizations
working in the fi eld. Control activities focus on the implementation of
the SAFE strategy, S urgery for trichiasis, A ntibiotics for infection, F acial
cleanliness (hygiene promotion) and E nvironmental improvements, to
reduce transmission of the organism (WHO 2003).
For mild trichiasis with a few peripheral lashes in the absence of
signifi cant entropion, epilation of the eyelashes may be a reasonable
alternative to surgery. Several chirurgic procedures (Merbs et al. 2005,
Bowman et al. 2000) are in routine use by trachoma control programs.
These generally involve a full thickness incision through the tarsal plate
combined with several everting sutures to turn the distal part of the eyelid
outwards. Others techniques described are the bilamellar tarsal rotation
(BLTR), and the posterior lamellar tarsal rotation (PLTR), including the
Trabut procedure.
One of the major problems is a high post-surgery trichiasis recurrence
rate, ranging from about 20% in the fi rst 2 yr to 60% after 3 yr (Merbs et al.
2005, Bowman et al. 2000).
The WHO recommends two antibiotic treatment regimes: either
1% tetracycline eye ointment twice daily for 6 wk or a single oral dose
of azithromycin. Azithromycin for trachoma control is not currently
recommended for children under 6 mon or pregnant women, and therefore
tetracycline ointment is the treatment of choice for these groups of patients
(Cochereau et al. 2007).
While oral azithromycin would seem to be a safe option, a potential
alternative is azithromycin eye drops. A clinical trial of short duration
azithromycin eye drops found that at 2 mon, the cure rate and safety of
topical 1.5% azithromycin twice a day for 3 d has a similar effi cacy as a single
oral 20 mg/kg dose of azithromycin for the treatment of active trachoma in
children was not inferior to oral azithromycin (Huguet et al. 2010).
CONCLUSIONS
The management of chronic progressive conjunctival infl ammation is a
challenge to the ophthalmologist, combining topical and systemic treatment
and controlling the toxicity induced by these treatments and side systemic
effects. In many cases a treatment combination is necessary to reduce the
conjunctival infl ammation.
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