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Review
. 2012 Mar-Apr;57(2):105-35.
doi: 10.1016/j.survophthal.2011.08.002. Epub 2012 Jan 27.

Trachomatous trichiasis and its management in endemic countries

Saul N Rajak  1 , J Richard O Collin, Matthew J Burton
Affiliations
Review

Trachomatous trichiasis and its management in endemic countries

Saul N Rajak et al. Surv Ophthalmol. 2012 Mar-Apr.

Abstract

Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva. This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries. The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.We examine the principles of clinical management, treatment options, and the challenging issues of providing the quantity and quality of surgery that is needed in resource-poor settings.

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Figures

Fig. 1
Fig. 1
The clinical signs of trachoma. A: Active trachoma with both follicles and intense inflammation. B: Trachomatous conjunctival scarring. C: Entropion trichiasis and corneal opacity. D: Phthisis. E: Misdirected lashes. F: Metaplastic lashes.
Fig. 2
Fig. 2
Cross-section of the upper eyelid.
Fig. 3
Fig. 3
Bilamellar tarsal rotation: A: Bilamellar incision. B: Horizontal mattress suture. C: Postoperative lid eversion.
Fig. 4
Fig. 4
Posterior lamellar tarsal rotation. A: Posterior lamellar incision. B: Dividing anterior and posterior lamellae. C: Horizontal mattress sutures. D: Postoperative lid eversion.
Fig. 5
Fig. 5
Tarsal advance and rotation. A: Posterior lamellar incision and division between posterior and anterior lamellae (arrow indicates 180° rotation of terminal tarsus). B: Rotation and suturing of terminal tarsus, inferior advancement and suturing of posterior lamella (arrow indicates inferior movement of posterior lamella).
Fig. 6
Fig. 6
A: Post-operative granuloma. B: Post-operative wound infection C: Postoperative lid notching.
See this image and copyright information in PMC

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