Trachoma

What is trachoma?

Trachoma is an eye disease caused by a bacterium called Chlamydia trachomatis. The infection can cause irreversible blindness. It’s an issue in poor and rural areas throughout the world with poorer hygiene, limited access to clean water and sanitation, and problems with crowding.

How common is trachoma?

In 2020, there were an estimated 32.8 million people in the world treated with antibiotics for trachoma, with over 42,000 people treated with surgery for the advanced form of the disease. About 1.9 million people are blind or visually impaired because of trachoma. Trachoma is responsible for about 1.4% of all cases of blindness throughout the world.

More than 40 countries classify trachoma as a public health issue, and Africa is the most affected continent. Other areas where trachoma exists include Asia, Australia, the Middle East and Central and South America.

What are the signs and symptoms of trachoma?

Signs and symptoms of early stages of trachoma include:

• Red and irritated eyes.
• Swollen eyelids.
• Blurred vision.
• Watery discharge from the eyes.
• Discharge from the nose.

Advanced trachoma, or trachomatous trichiasis, happens after you have repeated infections and bouts of inflammation. The inflammation causes scar tissue on the inside of your eyelids and misdirection of your eyelashes, both of which scrape against your cornea. Your cornea is the clear and curved “window” on the front of your eyes that helps your eyes focus. After repeated episodes of trachoma, your cornea becomes opaque, which means light can’t get through.

What are the signs and symptoms of advanced trachoma?

Signs and symptoms of advanced trachoma include:

• Tightened eyelids due to scar tissue.
• Inward-turning eyelashes because of the tight eyelids.
• Extreme eye pain caused by eyelashes scraping against your cornea.
• Light intolerance.
• Impaired vision, possible blindness.

What causes trachoma?

Trachoma is a bacterial infection that starts out being a little bit like pink eye (conjunctivitis), with symptoms of redness, irritation and discharge. Your provider can treat trachoma with an antibiotic in the early stages of the disease.

How does trachoma spread?

Trachoma spreads through personal contact, with infected discharge from eyes and noses touching other people’s hands or infected clothing or bedding. Flies can also spread the infectious discharge from one person to another. Symptoms can begin from five to 12 days after you’ve been exposed to the active infection.

Women and assigned female at birth and children are most often infected.

How is trachoma diagnosed?

An eye doctor will take a medical history and ask you questions. They’ll want to know if you’ve been in areas where trachoma is present. Your provider will do an eye exam. In addition, they may take a sample of any fluid by numbing your eye and swabbing it. They can send this to a lab to find out if the source of infection is Chlamydia trachomatis.

How is trachoma treated?

In early stages, your provider can treat and cure trachoma by giving you antibiotics. The two drugs recommended for trachoma are azithromycin and an ointment made with tetracycline.

Trachoma that isn’t treated, or trachoma that happens repeatedly, can develop into trachomatous trichiasis. Your provider may suggest surgery. This can change the position of eyelashes so they no longer scrape your eye. This should prevent further scarring.

Severe damage to your cornea may lead your provider to recommend a corneal transplant.

If trachoma isn’t treated, you won’t be able to reverse the blindness that occurs.

How can I reduce my risk of developing trachoma?

Improving access to water supplies and sanitation services is key to stopping trachoma. Other strategies include improving crowded housing and getting rid of fly populations. Authorities throughout the world are making efforts to putting these actions into place to try to eliminate trachoma and trachoma blindness everywhere. The primary prevention strategy has an acronym — SAFE:

• Surgery to repair advanced disease.
• Antibiotics for infections.
• Facial cleansing to stop the spread.
• Environmental changes like improved access to clean water and sanitation services.

Some areas give children antibiotics at least once a year when they’re between 1 and 9 years old. This effort is known as blanket therapy, or blanket antibiotic therapy. There are some concerns about antibiotic resistance.

On a personal level, you can do some things to protect yourself if you live in an area where trachoma exists, or if you visit an area with trachoma. These include:

• Pay attention to your hygiene. Make sure you clean your face well, removing any trace of discharge from your eyes and nose.
• Wash your hands well. Do this especially if you’re around children.
• Don’t share towels or bedding.
• If possible, avoid areas where there are flies.

What can I expect if I have trachoma?

Your outlook is good if you have one episode of trachoma and take antibiotics. The complications start when you’ve had repeated episodes of the condition and your corneas are affected.

With surgery to correct the position of your eyelashes, further damage to your cornea will end.

But blindness caused by trachoma can’t be cured.

When should I see my healthcare provider?

If you live or visit an area where trachoma exists and you have discharge from your eyes or nose, you should contact a healthcare provider. This is especially true if you have pain in your eyes. You should always contact a provider about pain in your eyes and other symptoms that concern you.

What is the difference between chlamydial conjunctivitis and trachoma?

Chlamydial conjunctivitis is an eye disease caused by the sexually transmitted infection (STI), chlamydia. The bacterium is the same as the one that causes trachoma, but the subtypes of the germ are different. Trachoma isn’t an STI.

A note from Cleveland Clinic

If you live in or visit an area known to have trachoma — an eye condition caused by a bacterium infection — it’s important to take precautions to prevent transmission. You can help yourself by practicing vigorous hand washing and facial cleanliness. If your eyes get red or irritated, make sure you contact your healthcare provider. They can give you antibiotics to clear up symptoms and infections.