02:03pm Wednesday 16 October 2019

Eyes on the patient – improving the treatment of trachoma

Trachomatous trichiasis (TT), a condition triggered by trachoma infection in which eyelids turn inward and eyelashes rub the surface of the eye, is a leading cause of blindness in low income countries.

In two recently published PLoS Medicine articles, researchers led by ophthalmologist Matthew Burton described two large trials involving more than 1,000 patients in Ethiopia, the country with the highest rates of TT (about 1.2 million sufferers).

In the first study, the team provided training and tools to perform epilation – safely pulling out the eyelashes – on patients with minor cases of TT and compared the outcomes with surgery. The scientists found, in the milder cases, the two procedures were comparable in preventing corneal scarring or deterioration in eye sight, suggesting that when surgery is not available or patients refuse it, epilation can be as effective in preserving sight.

The authors say: “Where surgery is available and patients are willing to accept it, surgery should be performed, as the disease tends to progress, albeit quite slowly. However, we suggest that for individuals with minor trichiasis (who represent about half of all those with trachomatous trichiasis) epilation should be considered where surgery is either not available or declined by the patient.”

In a separate trial, the researchers compared the outcome of using absorbable sutures with standard silk. The two materials proved equally effective, but absorbable sutures removed the need for the patients to return to the clinic to have them taken out, avoiding long journeys.

The authors say: “The logistical advantages of using absorbable sutures should be taken into consideration when considering the choice of suture material.”

The Band Aid Foundation (via Fight for Sight) and the Wellcome Trust funded the research.


Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, et al. (2011) Surgery Versus Epilation for the Treatment of Minor Trichiasis in Ethiopia: A Randomised Controlled Noninferiority Trial. PLoS Med 8(12): e1001136. doi:10.1371/journal.pmed.1001136

Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, et al. (2011) Absorbable Versus Silk Sutures for Surgical Treatment of Trachomatous Trichiasis in Ethiopia: A Randomised Controlled Trial. PLoS Med 8(12): e1001137. doi:10.1371/journal.pmed.1001137

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