Trichiasis and disability in a trachoma-endemic area of Tanzania.

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Abstract
TRACHOMA GENERALLY and trichiasis specifically represent a significant ophthalmologic public health problem in some countries in Asia and Africa1 but, until recently, few programs have focused on trachoma itself. The burden of disease associated with trachoma has been characterized by the number of cases of low vision and blindness caused by trachoma1,2 and the associated numbers of disability-adjusted and handicap-adjusted life years.3,4 The studies estimating disability-adjusted and handicap-adjusted life years associated with trachoma equated disability and handicap with low vision and blindness. None of these studies gave weight to the possibility of functional limitations among persons with trichiasis without visual acuity loss because of photophobia and eye pain that are commonly associated with trichiasis. As a result, while the prevalence of trichiasis has been described in several studies,5-10 the total burden associated with trichiasis, particularly in persons without visual acuity loss, has not been described well. Some prevalence studies suggest that the number of cases of trichiasis without visual acuity loss is greater than the number of cases of trichiasis with corneal opacity and visual acuity loss.5,11 Documenting a significant burden associated with trichiasis regardless of visual acuity loss would help capture the full effect of the condition.

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