Trachoma

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 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.

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.

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.

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.

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.

Your healthcare professional can diagnose trachoma through a physical examination or by sending a sample of bacteria from your eyes to a laboratory for testing. But lab tests aren't always available in places where trachoma is common.

Trachoma treatment options depend on the stage of the disease.

Medicines

In the early stages of trachoma, treatment with antibiotics alone may be enough to stop the infection. Your healthcare professional may prescribe tetracycline eye ointment or oral azithromycin (Zithromax).

The World Health Organization (WHO) recommends giving antibiotics to an entire community when more than 5% of children have been affected by trachoma. The goal of this guideline is to treat anyone exposed to trachoma and reduce its spread.

Surgery

Treatment of later stages of trachoma, including painful eyelid issues, may require surgery.

In eyelid rotation surgery, the surgeon makes a cut in your scarred lid and rotates your eyelashes away from your cornea. The procedure limits more corneal scarring and may help prevent further loss of vision.

If your cornea has become clouded enough to seriously harm your vision, cornea transplant may be an option that could improve vision.

You may have a procedure to remove eyelashes in some cases. This procedure, known as eyelash epilation, may need to be done repeatedly.

You're likely to start by seeing someone on your primary healthcare team if you or your child has symptoms of trachoma. Or you may be referred immediately to an eye specialist (ophthalmologist). When you make the appointment, ask if you need to do anything in the meantime, such as keeping your child home from school or child care.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment make a list of:

• Symptoms of the person seeking treatment, including any details about changes in vision.
• Key personal information, such as recent travel, use of new makeup products, and any change in contacts or glasses.
• All medicines and any vitamins or supplements taken by the person seeking treatment.
• Questions to ask your healthcare professional.

For eye irritation, some basic questions to ask include:

• What's the most likely cause of these symptoms?
• Other than the most likely cause, what are other possible causes for these symptoms?
• What kinds of tests are needed?
• Is the condition likely temporary or does it last a long time?
• What is the best course of action?
• Will this condition cause any long-term complications?
• Should my child or I follow any restrictions, such as staying home from school or work?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have any brochures or other printed material for me? What websites do you recommend visiting?

What to expect from your doctor

You're likely to be asked a number of questions, such as:

• Have you ever had a similar issue?
• When did you first begin experiencing symptoms?
• How severe are your symptoms? Do they seem to be getting worse?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Is anyone else in your household having similar symptoms?
• Have you been treating your symptoms with any medicines or eye drops?

What you can do in the meantime

While waiting for your appointment, practice good hygiene to reduce the possibility of spreading your condition. Follow these steps:

• Don't touch your eyes without first washing your hands.
• Wash your hands thoroughly and frequently.
• Change your towel and washcloth daily, and don't share them with others.
• Change your pillowcase often.
• Discard eye cosmetics, particularly mascara.
• Don't use anyone else's eye cosmetics or personal eye care items.
• Stop wearing contact lenses until your eyes have been evaluated. Then follow instructions on proper contact lens care.
• If your child is infected, have the child avoid close contact with other children.