Trachoma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Trachoma is a keratoconjunctivitis caused by ocular infection with particular serovars of Chlamydia trachomatis.
Antibiotics, in conjunction with facial cleanliness campaigns and environmental improvements targeted at communities at risk, aim to reduce the reservoir of infection within a population.
Occurs predominantly in children. Poor facial cleanliness may be the most important modifiable risk factor in children who develop trachoma.
Children who have had multiple or severe episodes of active trachoma may develop cicatricial disease in later life.
Trachomatous cicatricial disease is characterized by tarsal conjunctival scarring, predominantly of the upper lid, although scarring may be sub-epithelial and not always patent. It may ensue over the subsequent decades and lead to trachomatous trichiasis, corneal opacity, and subsequent loss of vision.

A red eye due to at least 1 inturned eyelash touching the globe (trachomatous trichiasis)

From the collection of Dr Hugh R. Taylor

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Eyelid eversion demonstrating follicles on the upper tarsal conjunctiva
A normal eyelid
Eyelid eversion demonstrating scars on the tarsal conjunctiva
A red eye due to at least 1 inturned eyelash touching the globe (trachomatous trichiasis)
Corneal opacity due to trachoma
Eyelid eversion demonstrating intense inflammation of the upper tarsal conjunctiva

Citations

Key Articles

World Health Organization. Trachoma control: a guide for programme managers. Jul 2006 [internet publication].[Full Text]
World Health Organization. Report of the 4th global scientific meeting on trachoma, Geneva, 27-29 November 2018. Jun 2019. [internet publication].[Full Text]
Evans JR, Solomon AW, Kumar R, et al. Antibiotics for trachoma. Cochrane Database Syst Rev. 2019 Sep 26;9:CD001860.[Abstract][Full Text]
Ejere HO, Alhassan MB, Rabiu M. Face washing promotion for preventing active trachoma. Cochrane Database Syst Rev. 2015 Feb 20;(2):CD003659.[Abstract][Full Text]
Burton M, Habtamu E, Ho D, et al. Interventions for trachoma trichiasis. Cochrane Database Syst Rev. 2015 Nov 13;(11):CD004008.[Abstract][Full Text]

Other Online Resources

International Coalition for Trachoma Control: about trachoma

Referenced Articles

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18. Emerson PM, Lindsay SW, Alexander N, et al. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Lancet. 2004 Apr 3;363(9415):1093-8.[Abstract]
19. Centers for Disease Control and Prevention. Water, sanitation, and environmentally related hygiene (WASH): trachoma. Jun 2022 [internet publication].[Full Text]
20. Emerson PM, Lindsay SW, Walraven GE, et al. Effect of fly control on trachoma and diarrhoea. Lancet. 1999 Apr 24;353(9162):1401-3.[Abstract]
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22. World Health Organization. Report of the 2nd global scientific meeting on trachoma. Aug 2003 [internet publication].[Full Text]
23. Oldenburg CE. One size does not fit all: achieving trachoma control by 2030. Am J Trop Med Hyg. 2019 Dec;101(6):1189-90.[Abstract][Full Text]
24. Renneker KK, Abdala M, Addy J, et al. Global progress toward the elimination of active trachoma: an analysis of 38 countries. Lancet Glob Health. 2022 Apr;10(4):e491-500.[Abstract][Full Text]
25. Harding-Esch EM, Holland MJ, Schémann JF, et al. Impact of a single round of mass drug administration with azithromycin on active trachoma and ocular Chlamydia trachomatis prevalence and circulating strains in The Gambia and Senegal. Parasit Vectors. 2019 Oct 22;12(1):497.[Abstract][Full Text]
26. Xiong T, Yue Y, Li WX, et al. Effectiveness of azithromycin mass drug administration on trachoma: a systematic review. Chin Med J (Engl). 2021 Sep 16;134(24):2944-53.[Abstract][Full Text]
27. Stewart AEP, Zerihun M, Gessese D, et al. Progress to Eliminate Trachoma as a Public Health Problem in Amhara National Regional State, Ethiopia: results of 152 population-based surveys. Am J Trop Med Hyg. 2019 Dec;101(6):1286-95.[Abstract][Full Text]
28. Nash SD, Chernet A, Weiss P, et al. Prevalence of ocular chlamydia trachomatis infection in Amhara Region, Ethiopia, after 8 years of trachoma control interventions. Am J Trop Med Hyg. 2023 Feb 1;108(2):261-7.[Abstract][Full Text]
29. Aragie S, Wittberg DM, Tadesse W, et al. Water, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trial. Lancet Glob Health. 2022 Jan;10(1):e87-95.[Abstract][Full Text]
30. World Health Organization. Trachoma control: a guide for programme managers. Jul 2006 [internet publication].[Full Text]
31. World Health Organization. Report of the 4th global scientific meeting on trachoma, Geneva, 27-29 November 2018. Jun 2019. [internet publication].[Full Text]
32. Solomon AW, Foster A, Mabey DC. Clinical examination versus Chlamydia trachomatis assays to guide antibiotic use in trachoma control programmes. Lancet Infect Dis. 2006 Jan;6(1):5-6.[Abstract]
33. Harding-Esch EM, Holland MJ, Schémann JF, et al. Diagnostic accuracy of a prototype point-of-care test for ocular Chlamydia trachomatis under field conditions in The Gambia and Senegal. PLoS Negl Trop Dis. 2011 Aug;5(8):e1234.[Abstract][Full Text]
34. Derrick TR, Sandetskaya N, Pickering H, et al. DjinniChip: evaluation of a novel molecular rapid diagnostic device for the detection of Chlamydia trachomatis in trachoma-endemic areas. Parasit Vectors. 2020 Oct 27;13(1):533.[Abstract][Full Text]
35. Gwyn S, Nute AW, Sata E, et al. The performance of immunoassays to measure antibodies to the chlamydia trachomatis antigen Pgp3 in different epidemiological settings for trachoma. Am J Trop Med Hyg. 2021 Aug 16;105(5):1362-7.[Abstract][Full Text]
36. World Health Organization. Report of the 3rd global scientific meeting on trachoma. Jul 2010 [internet publication].[Full Text]
37. Stelmach RD, Flueckiger RM, Shutt J, et al. The costs of monitoring trachoma elimination: Impact, surveillance, and trachomatous trichiasis (TT)-only surveys. PLoS Negl Trop Dis. 2019 Sep;13(9):e0007605.[Abstract][Full Text]
38. Negrel AD, Taylor HR, West S. Guidelines for rapid assessment for blinding trachoma. Geneva, Switzerland: World Health Organization and International Trachoma Initiative; 2001.[Full Text]
39. Senyonjo L, Aboe A, Bailey R, et al. Operational adaptations of the trachoma pre-validation surveillance strategy employed in Ghana: a qualitative assessment of successes and challenges. Infect Dis Poverty. 2019 Aug 27;8(1):78.[Abstract][Full Text]
40. Liu B, Cowling C, Hayen A, et al. Relationship between community drug administration strategy and changes in trachoma prevalence, 2007 to 2013. PLoS Negl Trop Dis. 2016 Jul 6;10(7):e0004810. [Abstract][Full Text]
41. West SK, Bailey R, Munoz B, et al. A randomized trial of two coverage targets for mass treatment with azithromycin for trachoma. PLoS Negl Trop Dis. 2013 Aug 29;7(8):e2415.[Abstract][Full Text]
42. Yohannan J, Munoz B, Mkocha H, et al. Can we stop mass drug administration prior to 3 annual rounds in communities with low prevalence of trachoma?: PRET Ziada trial results. JAMA Ophthalmol. 2013 Apr;131(4):431-6.[Abstract][Full Text]
43. Bella AL, Einterz E, Huguet P, et al. Effectiveness and safety of azithromycin 1.5% eye drops for mass treatment of active trachoma in a highly endemic district in Cameroon. BMJ Open Ophthalmol. 2020;5(1):e000531.[Abstract][Full Text]
44. Hu VH, Harding-Esch EM, Burton MJ, et al. Epidemiology and control of trachoma: systematic review. Trop Med Int Health. 2010 Jun;15(6):673-91.[Abstract][Full Text]
45. Khandekar R, Ton TK, Do Thi P. Impact of face washing and environmental improvements on reduction of active trachoma in Vietnam - a public health intervention study. Ophthalmic Epidemiol. 2006 Feb;13(1):43-52.[Abstract]
46. House JI, Ayele B, Porco TC, et al. Assessment of herd protection against trachoma due to repeated mass antibiotic distributions: a cluster-randomised trial. Lancet. 2009 Mar 28;373(9669):1111-8.[Abstract]
47. Amza A, Kadri B, Nassirou B, et al. A cluster-randomized trial to assess the efficacy of targeting trachoma treatment to children. Clin Infect Dis. 2017 Mar 15;64(6):743-50.[Abstract][Full Text]
48. Evans JR, Solomon AW, Kumar R, et al. Antibiotics for trachoma. Cochrane Database Syst Rev. 2019 Sep 26;9:CD001860.[Abstract][Full Text]
49. Porco TC, Gebre T, Ayele B, et al. Effect of mass distribution of azithromycin for trachoma control on overall mortality in Ethiopian children: a randomized trial. JAMA. 2009 Sep 2;302(9):962-8.[Abstract][Full Text]
50. O'Brien KS, Emerson P, Hooper PJ, et al. Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic review. Lancet Infect Dis. 2019 Jan;19(1):e14-25.[Abstract]
51. Rolfe RJ, Shaikh H, Tillekeratne LG. Mass drug administration of antibacterials: weighing the evidence regarding benefits and risks. Infect Dis Poverty. 2022 Jun 30;11(1):77.[Abstract][Full Text]
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54. International Coalition for Trachoma Control. Preferred practices for zithromax mass drug administration. Sep 2013 [internet publication].[Full Text]
55. Ejere HO, Alhassan MB, Rabiu M. Face washing promotion for preventing active trachoma. Cochrane Database Syst Rev. 2015 Feb 20;(2):CD003659.[Abstract][Full Text]
56. Czerniewska A, Versteeg A, Shafi O, et al. Comparison of face washing and face wiping methods for trachoma control: a pilot study. Am J Trop Med Hyg. 2020 Apr;102(4):740-3.[Abstract][Full Text]
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58. West SK, Emerson PM, Mkocha H, et al. Intensive insecticide spraying for fly control after mass antibiotic treatment for trachoma in a hyperendemic setting: a randomised trial. Lancet. 2006 Aug 12;368(9535):596-600.[Abstract]
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62. Habtamu E, Wondie T, Aweke S, et al. Posterior lamellar versus bilamellar tarsal rotation surgery for trachomatous trichiasis in Ethiopia: a randomised controlled trial. Lancet Glob Health. 2016 Mar;4(3):e175-84. [Abstract][Full Text]
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65. Woreta F, Munoz B, Gower E, et al. Three-year outcomes of the surgery for trichiasis, antibiotics to prevent recurrence trial. Arch Ophthalmol. 2012 Apr;130(4):427-31.[Abstract][Full Text]
66. Zhang H, Kandel RP, Atakari HK, et al. Impact of oral azithromycin on recurrence of trachomatous trichiasis in Nepal over 1 year. Br J Ophthalmol. 2006 Aug;90(8):943-8.[Abstract][Full Text]
67. Burton M, Habtamu E, Ho D, et al. Interventions for trachoma trichiasis. Cochrane Database Syst Rev. 2015 Nov 13;(11):CD004008.[Abstract][Full Text]
68. Adafrie Y, Redae G, Zenebe D, et al. Uptake of trachoma trichiasis surgery and associated factors among trichiasis-diagnosed clients in Southern Tigray, Ethiopia. Clin Ophthalmol. 2021;15:1939-48.[Abstract][Full Text]
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70. West ES, Munoz B, Imeru A, et al. The association between epilation and corneal opacity in eye with trachomatous trichiasis. Br J Ophthalmol. 2006 Feb;90(2):171-4.[Abstract][Full Text]
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