Trachoma is a bacterial infection of the eye spread by personal contact and by flies that have been in contact with discharge from the eyes or nose of an infected person. In the late stages of the disease the eyelashes turn in on the eye, known as trichiasis, causing pain every time the person blinks and damaging the cornea, leading in many cases to irreversible blindness.


Eyelid surgery


To prevent blindness, eyelid surgery is performed to correct the inturned lashes. “There are two operations currently used to treat late stages of trachoma,” explains Dr. David Mabey, Professor of Communicable Diseases, Clinical Research Unit at LSHTM. “Our team discovered that the operation recommended until recently by the World Health Organisation (WHO) is not the most effective.”

The research, carried out in Ethiopia on 1000 patients, showed that posterior lamellar surgery (PLTR) was more effective than bilamellar tarsal rotation (BLTR) surgery, with just 13 per cent of patients experiencing a recurrence of trichiasis compared to 22 per cent of those who received BLTR.

“The WHO have changed their guidelines as a result of this study, which is good news for the 3 million people with trichiasis waiting for an operation,” explains Mabey.


Eliminate blinding trachoma


The number of people living in trachoma-endemic districts is estimated to have fallen from 314 million in 2011 to 229 million in 2013, according to WHO. A Global Alliance, led by WHO, aims to eliminate blinding trachoma as a public health problem by 2020, using the SAFE strategy: Surgery for trichiasis, the Antibiotic azithromycin given as community-based mass treatment, promotion of Facial cleanliness and Environmental improvements.

“Trachoma is a disease of poverty, affecting the poorest people in the poorest communities in the poorest countries on earth,” continues Mabey. “The biggest challenge is in places where security is a concern, such as South Sudan and the Central African Republic.”

Seven countries have successfully met the elimination targets, but more research and investment will be needed to enable the Alliance to achieve the target of global elimination by 2020.