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ARTICLE
Year : 1961  |  Volume : 9  |  Issue : 4  |  Page : 72-76

Trachoma- Epidemiology and treatment


Department of Ophthalmology, Medical College, Amritsar, India

Date of Web Publication7-Apr-2008

Correspondence Address:
Tulsi Das
Department of Ophthalmology, Medical College, Amritsar
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Das T, Nirankari M S, Chaddah M R. Trachoma- Epidemiology and treatment. Indian J Ophthalmol 1961;9:72-6

How to cite this URL:
Das T, Nirankari M S, Chaddah M R. Trachoma- Epidemiology and treatment. Indian J Ophthalmol [serial online] 1961 [cited 2020 Jun 4];9:72-6. Available from: http://www.ijo.in/text.asp?1961/9/4/72/40279

Table 1

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Table 1

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It was in the year 1952 that study of our old and perennial enemy, trachoma, was started in this insti­tution. Trachoma is a serious health problem in this part of the country, hence it was decided to study the disease in detail. This study is in continuation of our earlier paper published in 1954 (Das, Nirankari and Chaddah).


  Details of Study and Results Top


2224 persons comprising of 1158 inhabitants of a village, 344 persons residing in a Harijan Colony (living in unhygenic conditions) and 722 students, below 20 years of age coming from middle class, were ex­amined. Palpebral conjunctiva, bul­bar conjunctiva, fornices and cornea were examined in detail with a corneal loupe and the stage of tra­choma and pannus noted in every case.

Incidence :- 96% school child­ren below 20 years of age, 99.05% villagers and 99.7% inhabitants of a Harijan Colony were found to be affected with trachoma.

Age Incidence:- No age was free from trachoma. Different age groups showed prepondrance of different stages of the disease. Stage II and stage III were com­monest in age group 21 to 40 and the complications were mostly met with after 40 years of age except in Harijan Colony where these were present even before the age of 10 years. In the age group 0 to 10, stage II was most common in in­habitants of Harijan Colony where­as in others stage I was predomin­ant.

Sex Incidence:- Females suf­fered more than males. Moreover, trachoma in females was severer.

Social Status:- Incidence of trachoma and its complications were maximum in Harijan Colony which is inhabited by the poor people living in most unhygienic conditions whereas it was less in a village where there was mixed population and least in school children of the town.

Pannus : Various stages of pannus were seen in 64.5% inhabit­ants of the village and Harijan Colony and in 23.1% students. Pannus was comparatively more advanced in the inhabitants of Harijan Colony.


  Treatment Top


For treatment, 351 patients be­longing to different strata of society were divided into five groups and four different drugs were tried on them so as to compare their efficacy. The treatment was carried out for two months in all cases. Clinical examination and con­junctival scrapings were examined for trachoma inclusions at the be­ginning and end of the treatment. The treatment was tried on the following five groups.

Group I. 99 children belonging to upper strata of society (students of Sacred Heart and Alexandra High School, Amritsar) were treat­ed with 0.5% terramycin ophthalmic ointment four times a day in both eyes.

Group II. In 31 patients, students of Alexandra High School, Amritsar, 5% synthomycetin (Chloram­phenicol) ophthalmic ointment was put four times a day in both eyes.

Group III. 82 poor children of St. Mary's High School, Amritsar, were treated with 0.5% terramycin ophthalmic ointment four times a day in both eyes.

Group IV. In 116 patients (77 policemen and 39 children of St. Mary's High School, Amritsar), 0.5% terramycin ophthalmic oint­ment was used in right eye four times a day and 10%, acetocid drops were instilled four times a day in the left eye.

Group V. In 23 policemen, 0.5% terramycin ophthalmic ointment was used in the right eye four times a day and 1% aureomycin ointment in the left eye four times a day.

The results of treatment were classified into four groups, i.e. (i) cure, (ii) improvement, (iii) no change and (iv) unchecked progress. This classification was based on the study of clinical picture and of inclusion bodies before and after treatment.

No allergic reactions were en­countered during the treatment. Some of the patients complained that they experienced glare and stickiness of the eyes, while using ointment. It was also observed that application of ointment requires special skill on the part of the patient otherwise about 50% of ointment goes waste. The use of drops was found to be more con­venient.


  Discussion Top


Present study reveals that tra­choma is widely prevalent in the State of Punjab, its incidence being 96% to 99.7%. Thus the disease is endemic in this State. According to Grover, the incidence of trachoma in the rural areas of Aligarh Dist­rict is about 80%. It is estimated that at least 20% of world popula­tion is afflicted but the distribution is quite uneven, (Thygeson). It can be said to be endemic in Egypt and Northern India, widespread throughout Asia and Southern and Eastern Europe and not uncommon in United States (Sidkey and Freyche). [Figure - 1],[Figure - 2],[Figure - 3] show that most of the victims get the in­fection before the age of 20 years. Trachoma is commoner and severer in females than males. The racial incidence could not be studied as this part of the country is inhabited by one race. According to Thyge­son, trachoma has high incidence among dark-skinned Mediterranean people though it tends to be mild in them. Negros show a relative resistance, perhaps epithelial cells containing pigment granules are less likely to be infected.

Mother is the commonest source of infection. Other methods of transmission of virus are through fingers, flies and fomites such as common towels and soap etc. The existence of sub-clinical infection or carrier state is another factor res­ponsible for the spread of the disease. The rate of progress of disease depends on care of eyes and treatment carried out. The patients belonging to upper strata of society may not complain of any symptoms of trachoma and it rarely goes to the stage of complications and sequelae whereas in poor people the complications are more common and appear at a very early date so much so that trichiasis was seen in children below 10 years of age. This higher incidence of tra­choma and its complications in poor could be due to lower resistance, unhygienic living conditions and secondary infection. Our findings substantiate the view commonly held that trachoma is a disease of poverty, poor personal hygiene and general uncleanliness. Higher incidence of pannus in poor and middle class people could also be due to secondary infection. Tra­choma is a chronic disease with many complications and if allowed to have its own way unchecked, it will do great harm in the long run, but its association with bacteria makes it worse. Therefore, the importance of improving the resist­ance, changing the environments and tackling the secondary in­vaders cannot be over-emphasized while considering the treatment of trachoma.

A comparative study of results of treatment in Group I and II shows that terramycin was more effective than synthomecetin ointment. More­over, it was found that the results were better in rich patients (Group I) than the poor (Group III), treated with terramycin ointment which could be due to better general hygienic conditions. In patients where terramycin ointment was used in one eye and acetocid drops in the other, latter proved to be comparatively better. In Group V, aureomycin ointment was found to be more effective. Our results with these drugs were not so encourag­ing as those of Mitsui and co­workers with terramycin ointment, Boase and Naccache with aure­omycin ointment and of Siniscal with sulphacetamide drops. We agree with Siniscal that response to therapy varies to great extent according to the country, climate, race and habits of patients. These may be responsible for difference in results obtained by various work­ers. Our results show that two months is too short a period to cure trachoma.


  Summary Top


Results of examination of 1158 inhabitants of a village, 344 persons residing in a Harijan Colony and 722 students of a school are presented.

2. Epidemiology of trachoma is discussed.

3. Role of 10% Acetocid drops, 1% Aureomycin ointment, 0.5% Terramycin ointment and 5% Syn­thomycetin ointment in treatment of trachoma is discussed.

4. In trachoma, treatment for two months is considered to be in­sufficient to get complete cure.

We are thankful to the staff and students of Sacred Heart High School, Amritsar, St. Mary's High School, Amritsar, Alexandra High School, Amritsar and Sant Singh Sukha Singh High School, Amritsar, for their co-operation during this work. We are thankful to Chas. Pfizer and Co. Inc., New York; Lederle Laboratories, New York; British Schering Corporation, Lon­don and Ranbaxy & Co. Ltd., New Delhi, for the generous supply of drugs. We are further thankful to Chas. Pfizer and Co. Inc., New York, for the grant given by them to carry out this work.[9]

 
  References Top

1.
Boase, A. J. (1950), Brit. J. Ophth. 34, 35 - 37.  Back to cited text no. 1
    
2.
Boase, A. J. (1950), Brit. J. Ophth. 34, 627-632.  Back to cited text no. 2
    
3.
Tulsi Das, Nirankari, M. S. and Chaddah, M. R. (1954), J. O. All India Ophth. Society, 2, 1-14.  Back to cited text no. 3
    
4.
Grower, A. D. (1960), J. I. M. A., 35, 57.  Back to cited text no. 4
    
5.
Mitsui, Y., Tanaka, C., Toya, H., Iwashige, Y. and Yamashita, K. (1951), Arch. Ophth. 46, 235-244.  Back to cited text no. 5
    
6.
Naccache, R. (1951). Am. J. Ophth. 34, 1591-1593­.  Back to cited text no. 6
    
7.
Sidkey, M.M., Freyche, M. J. (1919). Epidemiol. and Vital Statist. Rep. 2, 230.  Back to cited text no. 7
    
8.
Siniscal, A. A. (1952). Am. J. Ophth. 35, 671-683.  Back to cited text no. 8
    
9.
Thygeson, P. (1951). Am. J. Ophth. (Part II). 34 : 7.  Back to cited text no. 9
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]
 
 
    Tables

  [Table - 1]



 

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