|Year : 1961 | Volume
| Issue : 4 | Page : 72-76
Trachoma- Epidemiology and treatment
Tulsi Das, MS Nirankari, MR Chaddah
Department of Ophthalmology, Medical College, Amritsar, India
|Date of Web Publication||7-Apr-2008|
Department of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das T, Nirankari M S, Chaddah M R. Trachoma- Epidemiology and treatment. Indian J Ophthalmol 1961;9:72-6
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|| |
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|| |
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|| |
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|| |
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.
| References|| |
Boase, A. J. (1950), Brit. J. Ophth. 34, 35 -
Boase, A. J. (1950), Brit. J. Ophth. 34, 627-632.
Tulsi Das, Nirankari, M. S. and Chaddah, M. R. (1954), J. O. All India Ophth. Society, 2, 1-14.
Grower, A. D. (1960), J. I. M. A., 35, 57.
Mitsui, Y., Tanaka, C., Toya, H., Iwashige, Y. and Yamashita, K. (1951), Arch. Ophth. 46, 235-244.
Naccache, R. (1951). Am. J. Ophth. 34, 1591-1593.
Sidkey, M.M., Freyche, M. J. (1919). Epidemiol. and Vital Statist. Rep. 2, 230.
Siniscal, A. A. (1952). Am. J. Ophth. 35, 671-683.
Thygeson, P. (1951). Am. J. Ophth. (Part II). 34 : 7.
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]