The long-term natural history of trachomatous trichiasis in the Gambia.
OBJECTIVE
Trachoma is the leading infectious cause of blindness. However, there are few data on the natural history of trachomatous trichiasis to guide program planning or that investigate its pathogenesis.


METHODS
A cohort of Gambians with trichiasis in one or both eyes who had declined surgery was observed. Clinical examinations were performed at baseline and 4 years later. Conjunctival swab samples were collected for Chlamydia trachomatis PCR and bacteriology.


RESULTS
One hundred fifty-four people were examined at baseline and 4 years later (241 nonsurgical eyes). At baseline 124 (52%) eyes had major trichiasis (5+ lashes), 75 (31%) minor trichiasis (1-4 lashes), and 42 (17%) no trichiasis. By 4 years, trichiasis had developed in 12 (29%) of 42 previously unaffected eyes. Minor trichiasis progressed to major in 28 (37%) of 75 eyes. New corneal opacification more commonly developed in eyes that had major (10%) compared to minor (5%) trichiasis at baseline. Bacterial infection was common (23%), becoming more frequent with increasing trichiasis. C. trachomatis infection was rare (1%). Conjunctival inflammation was common (29%) and was associated with progressive trichiasis and corneal opacification.


CONCLUSIONS
Trichiasis progressed in the long-term in this environment, despite a low prevalence of C. trachomatis. Blinding corneal opacification develops infrequently, unless major trichiasis is present. Epilation and early surgery need to be formally compared for the management of minor trichiasis. The pathologic correlates and promoters of conjunctival inflammation need to be investigated.
Burton
Matthew J
MJ
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. metthew.burton@lshtm.ac.uk
Bowman
Richard J C
RJ
Faal
Hannah
H
Aryee
Esther A N
EA
Ikumapayi
Usman N
UN
Alexander
Neal D E
ND
Adegbola
Richard A
RA
Mabey
David C W
DC
Foster
Allen
A
Johnson
Gordon J
GJ
Bailey
Robin L
RL
D000368:Aged; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification; D003228:Conjunctiva / Q000382:microbiology; D003231:Conjunctivitis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003318:Corneal Opacity / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004269:DNA, Bacterial / Q000032:analysis; D018450:Disease Progression; D005140:Eyelashes; D005141:Eyelid Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006201:Hair Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D014141:Trachoma / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D014792:Visual Acuity
D004269:DNA, Bacterial