Trachoma

Overview

Trachoma (truh-KOH-muh) is a contagious eye infection caused by a bacterium called Chlamydia trachomatis. It spreads through contact with eye, nose or throat secretions, or by sharing contaminated items such as towels or eye makeup.

Early symptoms of trachoma include eye irritation, swollen eyelids and eye discharge. Without treatment, trachoma can lead to blindness. It is the world's leading preventable cause of blindness.

Trachoma mainly affects people in remote areas with limited access to clean water or healthcare. This includes regions of Africa, Asia, Latin America, the Middle East, and the Pacific Rim. Infection rates in children under 5 can reach 60%. Older children and adults are less likely to be infected due to stronger immunity and better hygiene.

Early treatment can help prevent serious complications.

Symptoms

Symptoms of trachoma usually affect both eyes and may include:

• Mild itching and irritation of the eyes and eyelids.
• Eye discharge that has mucus or pus.
• Eyelid swelling.
• Sensitivity to light.
• Eye pain.
• Eye redness.
• Vision loss.

Young children are particularly at risk of infection. But the disease progresses slowly, and the more painful symptoms may not appear until adulthood.

The World Health Organization (WHO) has named five stages in the development of trachoma:

• Follicular inflammation. In the early stage of infection, small bumps called follicles appear on the inside of the upper eyelid. These follicles are made up of white blood cells and can be seen with magnification.
• Intense inflammation. At this stage, the eye is very contagious and becomes red, swollen, and irritated, especially the upper eyelid.
• Eyelid scarring. Repeated infections cause scars to form on the inner eyelid. These may look like white lines when viewed closely. The eyelid can become misshapen and may start to turn inward.
• Inward-turning eyelashes, called trichiasis. As scarring continues, eyelashes may turn inward and rub against the surface of the eye, causing scratching and pain.
• Cloudy cornea, known as corneal opacity. Ongoing irritation and scratching from inward-turned lashes can lead to the clear front part of the eye becoming cloudy and affecting vision.

All the signs of trachoma are more severe in the upper lid than in the lower lid. Without intervention, a disease process that begins in childhood can continue to advance into adulthood.

When to see a doctor

Call a healthcare professional if you or your child has itchy or irritated eyes or discharge from the eyes, especially if you live in or recently traveled to an area where trachoma is common. Trachoma is a contagious condition. Treating it as soon as possible helps prevent serious infection.

Causes

Trachoma is caused by certain subtypes of Chlamydia trachomatis, a bacterium that also can 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 all can spread trachoma. In developing countries, eye-seeking flies also spread infection.

Risk factors

Factors that increase your risk of getting trachoma include:

• Crowded living conditions. People living in close contact are at greater risk of spreading infection.
• Poor sanitation. Poor sanitary conditions, limited access to water, 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. In some places, women are 2 to 6 times more likely than men to get the disease. This may be because women have more contact with children, who are the main source of the infection.
• Flies. People living in areas with problems controlling the fly population may be more susceptible to infection.

Complications

One bout of trachoma caused by Chlamydia trachomatis is easily treated with antibiotics if detected early. Repeated infections can lead to complications, including:

• Scarring of the inner eyelid.
• Eyelid issues, such as an inward-folding eyelid, called entropion, or ingrown eyelashes, called trichiasis. Both conditions can scratch the cornea.
• Scarring or cloudiness of the cornea.
• Partial or complete vision loss.

Prevention

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.

Trachoma can occur worldwide but is more common in parts of Africa, Asia, Latin America, the Middle East and the Pacific Rim. When in regions where trachoma is common, take extra care to practice good hygiene, which can help prevent infection.

Proper hygiene practices include:

• Face washing and hand-washing. Keeping faces and hands clean may help break the cycle of reinfection.
• Fly control. Reducing fly populations can help eliminate a 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.

No trachoma vaccine is available, but prevention is possible. WHO has developed a strategy titled SAFE to prevent trachoma. SAFE involves:

• Surgery to treat advanced forms of trachoma.
• Antibiotics to treat and prevent infection.
• Facial cleanliness.
• Environmental improvements, particularly in water, sanitation and fly control.