Trachomatous Trichiasis: Surgical Management and Impact

Background: Trachomatous trichiasis (TT), is the in-turning of eyelashes from long-term, progressive conjunctival scarring initiated by chlamydia trachomatis. It is the painful blinding stage of trachoma. We aimed to measure impact of TT on Quality of Life (QoL) and household poverty; identify the most effective of two commonly used surgical TT procedures; and measure impact of TT surgery on QoL and daily living. Methods: A randomized, controlled, single-masked clinical trial was conducted in Ethiopia comparing the bilamellar tarsal rotation (BLTR) and posterior lamellar tarsal rotation (PLTR) procedures (1000-participants). A case-control study was nested within the trial to measure QoL using standard quantitative tools, and household poverty using three economic measures (assetbased analysis, self-rated and peer-rated wealth) among TT cases and compared to healthy neighborhood controls (200-participants). These participants were followed-up after one year to measure impact of TT surgery on QoL and daily living using the same tools. Results: PLTR was the superior surgical procedure, with only 13% recurrent TT by 12-months compared to 22% in the BLTR (OR=1.96; 95%CI:1.40–2.75; p=0.0001). At baseline, TT cases were more likely to belong to poorer households with substantially lower QoL, less likely to participate in, more likely to report difficulty and assistance in performing productive and leisure activities regardless of visual impairment than controls. Twelve months after surgery, QoL scores of TT cases and their ability to perform daily activities without difficulty and assistance improved substantially, independent of the presence of visual acuity improvement. Conclusions: PLTR surgery appears to be superior in terms of reduced recurrence and complications for the programmatic management of TT. TT is associated with household poverty and is disabling and substantially reduces QOL. Corrective surgery improves QoL and functional capabilities of affected individuals even without vision gains and may contribute to improved household income and wealth.