![]() ![]() Trachoma control focuses on the implementation of the SAFE Strategy: Surgery for trichiasis, Antibiotics in the form of mass administration of azithromycin, Facial Cleanliness and Environmental Improvements to suppress the transmission of the infection. There is currently a major scale-up of the global control programme, which aims to eliminate the disease as a public health problem by the year 2020. Trachoma is endemic in 51 countries and is estimated to be responsible for 2.2 million cases of blindness or low vision. Blindness results from the corneal damage caused by trichiasis and secondary bacterial or fungal infection. As this becomes more extensive the eyelid becomes distorted and turns in (entropion), which can lead to the eyelashes touching the eye (trichiasis). Scarring, primarily of the upper tarsal conjunctiva, generally begins to appear in adolescence, and accrues with age it is characterised by thickened and disordered sub-mucosal collagen. Typically, the disease starts in early childhood with a follicular-papillary conjunctivitis, which is associated with a mixed inflammatory cell infiltrate. Similarly, the protective and pathological host responses in relation to progressive scarring have not been fully characterised. There is uncertainty over the relative importance of potential infectious drivers at different stages in the natural history of trachoma. However, a clear understanding of the immunopathological basis of this disease remains elusive. This obligate intracellular bacterium triggers prolonged inflammatory episodes in the conjunctival mucosa, which are believed to be central to the development of scarring. Blinding trachoma is the end result of the scarring sequelae of recurrent ocular Chlamydia trachomatis infection.
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