Definition

By Mayo Clinic Staff

Trachoma (truh-KOH-muh) is a bacterial infection that affects your eyes. The bacterium that
causes trachoma spreads through direct contact with the eyes, eyelids, and nose or throat
secretions of infected people.
Trachoma is very contagious and almost always affects both eyes. Signs and symptoms of
trachoma begin with mild itching and irritation of your eyes and eyelids and lead to blurred
vision and eye pain. Untreated trachoma can lead to blindness.
Trachoma is the leading preventable cause of blindness worldwide. The World Health
Organization (WHO) estimates that 8 million people worldwide have been visually impaired by
trachoma. WHO estimates more than 84 million people need treatment for trachoma, primarily in
poor areas of developing countries. In some of the poorest countries in Africa, prevalence among
children can reach 40 percent.
If trachoma is treated early, it often may prevent further trachoma complications.
Symptoms
The principal signs and symptoms in the early stages of trachoma include:
 Mild itching and irritation of the eyes and eyelids
 Discharge from the eyes containing mucus or pus
As the disease progresses, later trachoma symptoms include:
 Marked light sensitivity (photophobia)
 Blurred vision
 Eye pain
Young children are particularly susceptible to infection, but the disease progresses slowly, and
the more painful symptoms may not emerge until adulthood.
The World Health Organization has identified a grading system with five stages in the
development of trachoma, including:
 Inflammation — follicular. The infection is just beginning in this stage. Five or more
follicles — small bumps that contain lymphocytes, a type of white blood cell — are
visible with magnification on the inner surface of your upper eyelid (conjunctiva).
 Inflammation — intense. In this stage, your eye is now highly infectious and becomes
irritated, with a thickening or swelling of the upper eyelid.
  Eyelid scarring. Repeated infections lead to scarring of the inner eyelid. The scars often
appear as white lines when examined with magnification. Your eyelid may become
distorted and may turn in (entropion).
 Ingrown eyelashes (trichiasis). The scarred inner lining of your eyelid continues to
deform, causing your lashes to turn in so that they rub on and scratch the transparent
outer surface of your eye (cornea).
 Corneal clouding. The cornea becomes affected by an inflammation that is most
commonly seen under your upper lid. Continual inflammation compounded by scratching
from the in-turned lashes leads to clouding of the cornea. Secondary infection can lead to
development of ulcers on your cornea and eventually partial or complete blindness.
All the signs of trachoma are more severe in your upper lid than in your lower lid. With
advanced scarring, your upper lid may show a thick line. In addition, the lubricating glandular
tissue in your lids — including the tear-producing glands (lacrimal glands) — can be affected.
This can lead to extreme dryness, aggravating the problem even more.
When to see a doctor
Call your doctor if you or your child has itching, irritation or discharge from the eyes, especially
if you recently traveled to an area where trachoma is common. Trachoma is a contagious
condition, and it should be treated as soon as possible to prevent further infections.
Causes
Trachoma is caused by certain subtypes of Chlamydia trachomatis, a bacterium that can also
cause the sexually transmitted infection chlamydia.
Trachoma spreads through contact with discharge from the eyes or nose of an infected person.
Hands, clothing, towels and insects can all be routes for transmission. In the world's developing
countries, flies are a major means of transmission.
Risk factors
Factors that increase your risk of contracting trachoma include:
 Poverty. Trachoma is primarily a disease of extremely poor populations in developing
countries.
 Crowded living conditions. People living in close contact are at greater risk of spreading
infection.
 Poor sanitation. Poor sanitary conditions and lack of hygiene, such as unclean faces or
hands, help spread the disease.
 Age. In areas where the disease is active, it's most common in children ages 4 to 6.
 Sex. Women contract the disease at rates two to six times higher than those for men.
  Poor access to water. Households at greater distances from a water supply are more
susceptible to infection.
 Flies. People living in areas with problems controlling the fly population may be more
susceptible to infection.
 Lack of latrines. Populations without access to working latrines — a type of communal
toilet — have a higher incidence of the disease.
Complications
One episode of trachoma caused by Chlamydia trachomatis is easily treated with early detection
and use of antibiotics. However, repeated infection can lead to complications, including:
 Scarring of the inner eyelid
 Eyelid deformities
 Inward folding of the eyelid (entropion)
 Ingrown eyelashes
 Corneal scarring or cloudiness
 Partial or complete vision loss
Tests and diagnosis
Most people with trachoma in its initial stages display no signs or symptoms. In areas where the
disease is common, your doctor can diagnose trachoma through a physical examination or
through sending a sample of bacteria from your eyes to be cultured and tested in a laboratory.
Treatments and drugs
Trachoma treatment options depend on the stage of the disease.
Medications
In the early stages of trachoma, treatment with antibiotics alone may be enough to eliminate the
infection. The two drugs currently in use include a tetracycline eye ointment and oral
azithromycin (Zithromax). Although azithromycin appears to be more effective than tetracycline,
azithromycin is more expensive. In poor communities, the drug used often depends on which one
is available and affordable.
The World Health Organization (WHO) guidelines recommend giving antibiotics to an entire
community when more than 10 percent of children have been affected by trachoma, to treat
anyone who has been exposed to trachoma and reduce the spread of trachoma.
Surgery
Treatment of later stages of trachoma — including painful eyelid deformities — may require
surgery. WHO guidelines recommend surgery for people with the advanced stage of trachoma.
In eyelid rotation surgery (bilamellar tarsal rotation), your doctor makes an incision in your
scarred lid and rotates your eyelashes away from your cornea. The procedure limits the
progression of corneal scarring and can help prevent further loss of vision. Generally, this
procedure can be performed on an outpatient basis and often significantly reduces the chances of
trachoma returning.
If your cornea has become clouded enough to seriously impair your vision, corneal
transplantation may be an option that may improve vision. Frequently, however, with trachoma,
this procedure doesn't have good results.
You may have a procedure to remove eyelashes (epilation) in some cases. However, this
procedure may need to be done repeatedly. Another temporary option, if surgery isn't an
available option, is to place an adhesive bandage over your eyelashes to keep them from
touching your eye.
Prevention
If you're traveling to parts of the world where trachoma is common, be sure to practice good
hygiene to prevent infection.
If you've been treated for trachoma with antibiotics or surgery, reinfection is always a concern.
For your protection and for the safety of others, be sure that family members or others you live
with are screened and, if necessary, treated for trachoma.
Proper hygiene practices include:
 Face washing and hand-washing. Keeping faces clean, especially children's, can help
break the cycle of reinfection.
 Controlling flies. Reducing fly populations can help eliminate a major source of
transmission.
 Proper waste management. Properly disposing of animal and human waste can reduce
breeding grounds for flies.
 Improved access to water. Having a fresh water source nearby can help improve
hygienic conditions.
Although no vaccine is available, trachoma prevention is possible. The World Health
Organization (WHO) has developed a health strategy to prevent trachoma, with the goal of
eliminating trachoma in the world by 2020. The strategy is titled SAFE, which includes:
 Surgery to treat advanced forms of trachoma
 Antibiotics to treat the infection and prevent further spread of infection
 Facial cleanliness
 Environmental improvements, particularly in water, sanitation and fly control, to lower
disease transmission