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Trachoma

by Melvin I. Roat, MD, FACS

Trachoma (also called granular conjunctivitis or Egyptian ophthalmia) is a prolonged infection of the conjunctiva caused by the bacterium Chlamydia trachomatis.

  • Chlamydia trachomatis can infect the eye, usually in children who live in lesser-developed, hot, dry countries.

  • Eye redness, watering, irritation, and, if severe, scarring and loss of vision may develop.

  • Antibiotics are usually effective.

Trachoma results from infections with certain nonsexually transmitted strains of Chlamydia trachomatis. Trachoma is common in dry, hot countries in North Africa, the Middle East, the Indian subcontinent, Australia, and Southeast Asia. In the United States, trachoma is rare, occurring occasionally among Native Americans and among immigrants from areas where trachoma is common. Trachoma is the leading preventable cause of blindness in the world.

The disease occurs mainly in children, particularly those between the ages of 3 and 6. Older children and adults are much less likely to have the disorder because of increased immunity and better personal hygiene.

Trachoma is contagious in its early stages and may be transmitted by eye-hand contact, by flies, or by sharing contaminated articles, such as towels, handkerchiefs, and eye makeup.

Symptoms

Trachoma usually affects both eyes. The conjunctivae (the membranes that line the eyelid and cover the white of the eye) become inflamed, red, and irritated, and the eyes water excessively. The eyelids swell. Sensitivity to bright light occurs.

In the later stages, blood vessels may gradually grow across the cornea (neovascularization), obstructing vision. In some people, the eyelid is scarred in such a way that the eyelashes turn inward (trichiasis). As the person blinks, the eyelashes rub against the cornea, causing infection and often permanent damage. Impaired vision or blindness occurs in about 5% of people with trachoma.

Diagnosis

Doctors suspect trachoma based on the appearance of the eyes and on the duration of symptoms. The diagnosis can be confirmed by sending a sample from the eye to a laboratory, where the infecting organism is identified.

Did You Know...

  • Trachoma is the leading preventable cause of blindness in the world.

Prevention

Because the disease is contagious, reinfection commonly occurs. Access to water that is suitable for drinking (potable) can reduce reinfection. Regular hand and face washing helps prevent spread. Sharing towels, washcloths, bedding, and eye makeup should be avoided. Because flies can transfer the disease among people, places where flies can breed should be eliminated.

Treatment

Treatment consists of an antibiotic (such as azithromycin, doxycycline, or tetracycline) taken by mouth. Alternatively, tetracycline or erythromycin can be applied as an ointment. Doctors often give antibiotics to entire neighborhoods where there are many people with trachoma. If the condition damages the eyelid, conjunctiva, or cornea, surgery may be needed.

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Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • ACHROMYCIN V
  • ZITHROMAX
  • ERY-TAB, ERYTHROCIN
  • PERIOSTAT, VIBRAMYCIN