Trachoma

Trachoma is caused by infection with the bacteria Chlamydia trachomatis.

The condition occurs around the world. It is most often seen in rural areas of developing countries. Children are often affected. However, the scarring caused by the infection may not be noticed until later in life. The condition is rare in the United States. However, it is more likely to occur in crowded or unclean living conditions.

The bacteria that cause trachoma are spread through direct contact with infected eye, nose, or throat fluids. They can also be passed by contact with contaminated objects, such as towels or clothes. Certain flies can also spread the bacteria.

Symptoms begin 5 to 12 days after being exposed to the bacteria. The condition begins slowly. It first appears as inflammation of the tissue lining the eyelids (conjunctivitis, or "pink eye"). Untreated, this may lead to scarring.

Symptoms may include:

• Cloudy cornea
• Discharge from the eye
• Swelling of lymph nodes just in front of the ears
• Swollen eyelids
• Turned-in eyelashes

The health care provider will do an eye exam to look for scarring on the inside of the upper eye lid, redness of the white part of the eyes, and new blood vessel growth into the cornea.

Lab tests are needed to identify the bacteria and make an accurate diagnosis.

Antibiotics can prevent long-term complications if used early in the infection. In certain cases, eyelid surgery may be needed to prevent long-term scarring, which can lead to blindness if not corrected.

Outcomes are very good if treatment is started early before scarring and changes to the eyelids develop.

If the eyelids become very irritated, the eyelashes may turn in and rub against the cornea. This can cause corneal ulcers, additional scars, vision loss, and possibly, blindness.

Contact your provider if you or your child recently visited an area where trachoma is common and you notice symptoms of conjunctivitis.

Spread of the infection can be limited by washing your hands and face often, keeping clothes clean, and not sharing items such as towels.

Granular conjunctivitis; Egyptian ophthalmia; Conjunctivitis - granular; Conjunctivitis - chlamydia

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Ramadhani AM, Derrick T, Macleod D, et al. Ocular immune responses, chlamydia trachomatis infection and clinical signs of trachoma before and after azithromycin mass drug administration in a treatment naïve trachoma-endemic Tanzanian community. PLoS Negl Trop Dis. 2019;13(7):e0007559. PMID: 31306419 pubmed.ncbi.nlm.nih.gov/31306419/.

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Sata E, Nute AW, Astale T, et al. Twelve-year longitudinal trends in trachoma prevalence among children aged 1-9 years in Amhara, Ethiopia, 2007-2019. Am J Trop Med Hyg. 2021;104(4):1278-1289. PMID: 33534757 pubmed.ncbi.nlm.nih.gov/33534757/.

Updated by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.