Purchase this article with an account.
M. Burton, R.J. C. Bowman, H. Faal, R.A. Adegbola, A. Foster, D.C. W. Mabey, R.L. Bailey; The Natural History of Trachomatous Trichiasis in the Gambia . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5017.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: Trachoma is the leading infectious cause of blindness. Approximately 10 million people have trichiasis, however, many have no access to or refuse surgery. There is little long–term data on the natural history of trichiasis. Some trachoma control programmes advocate early tarsal rotation surgery when only one or two lashes touch the eye. Other programmes, such as The Gambia, delay surgery until "major trichiasis" (5+ lashes) develops, preferring regular epilation for minor trichiasis (<5 lashes). Methods: A cohort of subjects from The Gambia with trachomatous trichiasis in one or both eyes was recruited. Following clinical examination, surgery was offered, but generally declined. Subjects were revisited four years later. Clinical examination was repeated. Conjunctival swab samples were collected for Chlamydia trachomatis PCR and bacteriology. Results: 154 people with trichiasis were examined at baseline and four years later. The mean age was 59 years and 71% were female. Following baseline examination 65 subjects had surgery on one eye; leaving 243 eyes in this analysis. At baseline 124 (51%) had major trichiasis, 76 (31%) had minor trichiasis (<5 lashes) and 43 (17%) had no trichiasis (unilateral disease). Four years later 12 / 43 (28%) of the unilateral cases had become bilateral. Minor trichiasis progressed to major in 26 / 76 (34%) eyes. Minor trichiasis resolved in 21 / 76 (28%). Corneal opacification was more common in major (22%) compared to peripheral minor (5%) trichiasis. Bacteria were isolated from 23% of eyes, becoming increasingly common with increasing trichiasis: no trichiasis 0%, minor trichiasis 11% and major trichiasis 29%. C. trachomatis infection was rare (2%). Severe tarsal conjunctival inflammation was common (29%) and associated with increasing severity of trichiasis. Conclusions: Trichiasis progresses relatively slowly in the long–term. In this environment this may have been related to a low prevalence of C. trachomatis. Blinding corneal opacification develops infrequently unless major or central trichiasis is present. Therefore, the decision to defer surgery until major or central trichiasis develops appears reasonable.
This PDF is available to Subscribers Only