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Medically reviewed by Tina Patel, Contact Lens Optician on 10th March 2023.
- What is trachoma?
- What causes trachoma symptoms?
- Is trachoma common?
- What trachoma treatment is available?
- Are there methods of trachoma prevention?
What is trachoma?
Trachoma is an infectious disease, usually affecting both eyes, that is attributed as the world’s largest contributor to preventable irreversible blindness from infection.
Tina Patel, Contact Lens Optician at Feel Good Contacts says: “Trachoma the most prevalent eye-related global public health problem today, affecting 42 countries in a significant way. Combatting the spread of Trachoma is an ongoing challenge.”
Main symptoms of trachoma
The symptoms of trachoma appear in stages and progress differently depending on severity as well as how quickly the condition is diagnosed and treated. Symptoms can progress very slowly. Children are more susceptible to the infection than adults, but as such, they may only start to display the more painful symptoms as they enter adulthood.
Early signs of trachoma usually affect both eyes and can easily be mistaken for a mild eye infection such as conjunctivitis (also known as pink eye). From five to 12 days of exposure, these early symptoms can be detected. Infected people will experience mild itching at the eyelids, eye irritation and discharge from the eyes.
The core trachoma symptoms are commonly more severe in the upper lid than the lower lid. They include:
- Mild itching and irritation of the eyes and eyelids
- Eye discharge containing mucus or pus
- Eyelid swelling
- Light sensitivity (effects of photophobia)
- Eye pain
- Eye redness
- Blurred vision
- Vision loss
Stages of trachoma
The stages of trachoma symptoms defined by The World Health Organization (WHO) are classified under five grades of development.
- Trachomatous Inflammation – Follicular (TF) – requires topical treatment
- Trachomatous Inflammation – Intense (TI) – topical and systemic treatments are considered
- Trachomatous Scarring (TS) – visible scars appear in the tarsal conjunctiva (lines the inside of the eyelid) and introduce risk of obscuring tarsal blood vessels
- Trachomatous Trichiasis (TT) – eyelid surgery referral is necessary
- Corneal Opacity (CO) – irreversible blindness is unavoidable
Complications of trachoma
As the infection progresses, trachoma causes complexities that lead to more severe eye pain and blurred vision.
Left untreated, the eyelids can become severely scarred (trachomatous conjunctival scarring). This scarring triggers a condition called trichiasis, wherein the eyelashes turn inward toward the eye and repeatedly scratch the cornea (trachomatous trichiasis), sometimes developing into the severe symptoms of entropion eye.
This puts the sufferer in constant pain, discomfort and can lead to light sensitivity (photophobia). Routine irritation caused by the eyelashes creates clouding on the cornea, leading to corneal ulcers and eventually vision loss.
What causes trachoma symptoms?
Trachoma is a contagious infection caused by a bacterium subtype of Chlamydia Trachomatis, which is related to the sexually transmitted infection chlamydia. Once infected, sufferers will experience trachoma symptoms resembling mild eye irritation followed by more severe and painful symptoms.
Contact with any discharge from the eyes or nose from the trachoma symptoms of an infected person can pass the infection from one person to another. Transmission is also possible via hands, clothing, towels and insects that have been in contact with the bacteria.
Is trachoma common?
Trachoma is uncommon in western areas of the world like USA and Europe. However, it is hyperendemic in Africa, Central and South America, Asia, Australia and the Middle East, most prevalent in the poorest and most rural areas of those countries.
This severe eye infection is responsible for 1.9 million cases of blindness and vision impairment, and around 1.4% of all blindness worldwide. 85% of active cases of trachoma can be localised to Africa.
Preschool-aged children are the group most susceptible to trachoma infections. Within this group in active areas of endemic, prevalence rates of trachoma symptoms can reach 60–90% of children.
Statistics show that blindness from trachoma is more common in women, up to 4 times more likely to display trachoma symptoms than men. This can be explained by social and cultural factors which place women in close proximity with infected children more frequently.
How is trachoma spread?
As a contagious infection, trachoma spreads through contact with infected matter. Where people live in densely populated areas and cramped living conditions where the active trachoma symptoms are present, transmission is strongest through family.
The immune system can easily cope with a single episode of trachoma infection, but in endemic communities where the infectious organism is common, exposure to trachoma symptoms and re-acquisition of the infection is more difficult to avoid and can lead to multiple re-infections.
Other environmental and social risk factors that contribute to the prevalence of transmission include:
- Poor hygiene
- Crowded living conditions
- Insufficient access to water
- Inadequate sanitation practices
- Poorly controlled management of flies
- Age-related risk factors which contribute to transmission risk
- Gender roles within communities
Is trachoma treatment available?
Antibiotics have been demonstrated to be effective in trachoma treatment. It is also suggested that early detection and treatment can prevent damaging long-term complications.
Early signs of trachoma can be identified from signs of suspected conjunctivitis through an eye exam if trachoma is suspected. If the patient has travelled in an area of high prevalence to trachoma, the eyecare professional may take a swab of the eye for confirmation in a lab.
A doctor or eyecare professional can easily diagnose a mature case of trachoma by examining the eyes to reveal:
- Inward-facing eyelashes
- Inner eyelid scarring
- New visible blood vessels in the cornea
If the infection is more advanced, trachoma treatment is still possible but surgery may be necessary. Procedures such as eyelash repositioning help to prevent further scarring of the cornea and stop blindness from developing, whereas more severe scarring can be addressed with a corneal transplant.
Even when trachoma has been treated with antibiotics or surgery, the risk of reinfection should be considered a priority. Monitoring yourself and family members for recurring infections is an important step in long-term recovery.
Feel Good Contacts gives ongoing support to charitable organisations like Orbis which are dedicated to offering relief from life changing eye problems like trachoma across the globe.
Are there methods of trachoma prevention?
While there is no vaccine available to stop the spread of trachoma, the disease takes years to develop into vision loss, so permanent impacts on vision are largely preventable.
A single trachoma infection is easily treatable and unlikely to cause long-term problems. What caused trachoma to develop into a long-term illness is recurring infections. Eyecare professionals widely believe that recurring infection is the dominant cause of scarring and blinding complications.
With the correct hygiene practices and adequate living conditions, trachoma can be prevented without the need for specific trachoma treatment.
The WHO adopted a strategy known as SAFE in 1993 to better manage trachoma and report progress towards reducing the global impact of the condition. This strategy lays out plans to eliminate trachoma as a public health problem by providing:
- Surgery for trichiasis
- Antibiotics to clear chlamydia trachomatis infection
- Facial cleanliness
- Environmental improvement to reduce transmission
The Global Elimination of Trachoma was later launched in 2020 to support successful implementation of the SAFE strategy by member states.