eye disorders
Trachoma
Treatment of Trachoma
Antibiotics, preferably systemic but alternatively topical Surgery for eyelid deformities and/or corneal opacity SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) program in endemic areas The World Health Organization (WHO) recommends that individual or sporadic cases of trachomatous inflammation–follicular be treated topically. The WHO also recommends topical treatment for trachomatous inflammation–intense, but that systemic treatment should be considered. Trachomatous scarring alone does not require treatment until it progresses to cause trachomatous trichiasis. For systemic treatment, a single oral dose ofazithromycin20 mg/kg (maximum 1 g) is 78 to 95% effective. As an additional benefit, the use of oralazithromycinhas been associated with a significant reduction in overall childhood mortality. Alternatives includeerythromycin500 mg twice daily for 14 days ordoxycycline100 mg twice a day for 10 days (not to be used in pregnant or breastfeeding women or in children under the age of 8). For topical treatment,tetracycline1% ointment to both eyes twice a day for 6 weeks can be used. The WHO recommends eyelid surgery for trachomatous trichiasis. If corneal opacity has advanced into the central cornea, it is considered the stage of untreatable irreversible blindness. In resource-rich nations a Corneal Transplantation could restore vision. The procedure is complex, and the frequent and intense aftercare to prevent rejection and infection makes corneal transplant impractical for many patients in most resource-limited nations. The WHO has endorsed a 4-step program for control of trachoma in endemic areas. This program is known as SAFE: urgery to correct eyelid deformities (eg, Entropion and trichiasis) that place patients at risk of blindness Antibiotics to treat individual patients and mass drug administration to reduce the disease burden in the community Facial cleanliness to reduce transmission from infected individuals Environmental improvement (eg, access to potable water and improved sanitation) to reduce transmission of disease and reinfection of patients In hyperendemic areas, mass administration to the entire community older than 6 months of a single oral dose ofazithromycin20 mg/kg (maximum 1 g) ortetracyclineorerythromycinophthalmic ointment applied twice daily for 5 consecutive days each month for 6 months has been effective as treatment and prophylaxis. Endemic trachoma has been dramatically reduced by using community-wide oralazithromycinin a single dose or in repeated doses. However, reinfection due to re-exposure is common in endemic areas. Reinfections can be reduced with fly control; better access to clean water, washing, and sanitation; building more hygienic latrines; and moving livestock and latrines farther from family living quarters. 