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S. N. Rajak, E. Habtamu, A. Bedri, P. M. Emerson, C. Gilbert, M. J. Burton, LSHTM/CC TTT project; Clinical Features of Trachomatous Trichiasis in Ethiopia. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5049.
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Trachoma is the leading infectious cause of blindness worldwide. Ten million people have trachomatous trichiasis (TT). WHO recommends trichiasis surgery should be performed when one or more lashes touch the eye, using tarsal rotation operations designed to correct entropion. However, it has been observed that some patients with TT have metaplastic or misdirected lashes, in the absence of entropion. In such patients entropion surgery is probably inappropriate and may fail to treat the problem. Here we describe the detailed clinical features of TT in Ethiopia.
Consecutive patients with previously unoperated TT presenting for surgery were examined. The disease was phenotyped in detail, including the number and nature of trichiatic lashes and degree of entropion.
We enrolled 2591 people. The median age was 50 years and 1879 (72%) were woman. Amongst these 2591 people were 4380 eyes with previously unoperated TT or clear evidence of epilation. Median number of lashes touching the eye was 2 (IQR: 1 - 5, range 0-132): 755 (17%) were epilated with no lashes touching the eye, 2534 (58%) eyes had minor trichiasis (1-5 lashes ) and 1091 (25%) had major trichiasis (6+lashes). In eyes with lashes touching the globe, the lashes were metaplastic/misdirected (aberrant) in 2775 (77%), entropic in 739 (20%) and mixed entropic/aberrant in 111 (3%). Severe, mild and no entropion is present in 715 (16%) eyes, 2626 (60%) eyes and 1039 (24%) eyes respectively. Entropion was associated with more severe trichiasis (OR 2.57, 95% CI: 2.36-2.78 p<0.005); only 279 (8%) of eyes with minor trichiasis had severe entropion.
It is commonly said that TT is secondary to cicatricial entropion. However, this large consecutive series of patients from a region with one of the most severe TT problems in the world demonstrates that in the majority of cases TT lashes were metaplastic or misdirected in the absence of frank entropion. This finding was even more marked for patients with Minor TT. The WHO currently recommends entropion surgery for Minor TT. However, given the previously described high recurrence rates and that many cases do not have significant entropion, it may be appropriate to consider alternative management strategies.
Clinical Trial: :
www.clinicaltrials.gov NCT00522912 and NCT00522912
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