228 Where There Is No Doctor 2011
Signs of river blindness:
• Several months after a black fly bites and the
worms enter the body, lumps begin to form
under the skin. In the Americas the lumps are
most common on the head and upper body; in
Africa on the chest, the lower body, and thighs.
Often there are no more than 3 to 6 lumps. They
grow slowly to a size of 2 to 3 cm. across. They
are usually painless.
• There may be itching when the baby worms are
spreading.
• Pains in the back, shoulder or hip joints, or
‘general pains all over’.
• Enlargement of the lymph nodes in the groin.
• Thickening of the skin on the back or belly, with
big pores like the skin of an orange. To see this,
look at the skin with light shining across it from
one side.
• If the disease is not treated, the skin gradually becomes more wrinkled, like an old
man’s. White spots and patches may appear on the front of the lower legs. A dry
rash may appear on the lower limbs and trunk.
• Eye problems often lead to blindness. First there may be redness and tears, then
signs of iritis (p. 221). The cornea becomes dull and pitted as in xerophthalmia
(p. 226). Finally, sight is lost because of corneal scarring, cataract, glaucoma, or
other problems.
Treatment of river blindness:
Early treatment can prevent blindness. In areas where river blindness is known to
occur, seek medical testing and treatment when the first signs appear.
♦ Ivermectin (Mectizan) is the best medicine for river blindness, and it may be
available at no cost through your local health department. Diethylcarbamazine and
suramin are other medicines used to treat river blindness, but these can sometimes
do more harm than good, especially when eye damage has already begun. They
should only be given by experienced health workers. For dosage and precautions
on all these medicines, see p. 377.
♦ Antihistamines help reduce itching (p. 385).
♦ Early surgical removal of the lumps lowers the number of worms.
Prevention:
♦ Black flies breed in fast-running water. Clearing brush and vegetation back from the
banks of fast-running streams may help reduce the number.
♦ Avoid sleeping out-of-doors—especially in the daytime, which is when the flies
usually bite.
♦ Cooperate with programs for the control of black flies.
♦ Early treatment prevents blindness and reduces spread of the disease.