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Br J Ophthalmol 2002;86:339-343 doi:10.1136/bjo.86.3.339
  • Original Article

Longitudinal study of trachomatous trichiasis in the Gambia

  1. R J C Bowman1,2,
  2. H Faal2,
  3. M Myatt1,
  4. R Adegbola4,
  5. A Foster3,
  6. G J Johnson1,
  7. R L Bailey3,4
  1. 1International Centre for Eye Health, 11–43 Bath Street, London EC1V 9EL, UK
  2. 2National Eye Care Program of the Gambia, PO Box 950 Banjul, Gambia
  3. 3Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
  4. 4Medical Research Council Laboratories, Fajara, PO Box 273, Banjul, Gambia
  1. Correspondence to: Mr R J C Bowman, International Centre for Eye Health, 11–43 Bath Street, London EC1V 9EL, UK; richardbowman{at}iceh.freeserve.co.uk
  • Accepted 15 October 2001

Abstract

Aim: Investigation of the natural history of trachomatous trichiasis in the Gambia and of the outcome of self epilation and surgery for the condition.

Methods: A 1 year longitudinal study of 190 subjects with trichiasis was performed. Major trichiasis cases (five lashes or more) were referred for surgery and minor trichiasis cases were advised to epilate. Outcome measures included progression of trichiasis and corneal scarring; attendance for and results of surgery.

Results: 34 of 148 (23%, 95% CI 16 to 31) subjects with major trichiasis attended for surgery over the year. Progression from minor to major trichiasis occurred in 18 of 55 subjects (33%, 95% CI 21 to 47). Progression of corneal scarring occurred in 60 of 167 patients (36%, 95% CI 29 to 44). Clinically active trachoma and conjunctival bacterial isolation predicted progression of corneal opacity. Surgery was successful in 39 of 54 (72%) eyes.

Conclusions: Despite the overall decline in trachoma in the Gambia, patients with both minor and major trichiasis remain at risk of developing corneal opacity. Active trachomatous inflammation and additional infection with bacteria may accelerate this process. Antibiotic treatment for trichiasis patients (in addition to surgery) should be investigated. Surgery for minor trichiasis may be indicated. Regular audit of surgical results is necessary with retraining where needed.

Footnotes

    Responses to this article

    • Critical appraisal of Epilation for trichiasis
      • Mandeep Singh Bajaj
      Br J Ophthalmol published online September 14, 2009

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