Merck Manual

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(Egyptian Ophthalmia; Granular Conjunctivitis)


Zeba A. Syed

, MD, Wills Eye Hospital

Reviewed/Revised Apr 2023
Topic Resources
  • 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 effective, but re-infection is common.

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 American Indians and among immigrants from areas where trachoma is common. Trachoma is the leading preventable cause of blindness in the world.

An Inside Look at the Eye

An Inside Look at the Eye

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.

The Conjunctiva

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 of Trachoma

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 (called neovascularization), obstructing vision. In some people, the eyelid is scarred in such a way that the eyelashes turn inward (trichiasis Trichiasis Trichiasis is misalignment of eyelashes, which rub against the eyeball, in a person who does not have entropion. Trichiasis develops most commonly some time after chronic blepharitis (inflammation... read more 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 of Trachoma

  • A doctor's evaluation of the symptoms and appearance of the eye

Doctors suspect trachoma based on the appearance of the eyes and on the duration of symptoms. The diagnosis of trachoma can be confirmed by swabbing the eye and sending the sample to a laboratory, where the infecting organism is identified, but often such testing is not necessary because the diagnosis is clear.

Did You Know...

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

Treatment of Trachoma

  • Antibiotics taken by mouth or applied as ointment

Treatment of trachoma 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.

Prevention of Trachoma

Because trachoma 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.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
Emtet-500, Panmycin, Sumycin
A/T/S, Akne-mycin, E.E.S., Emcin Clear , EMGEL, E-Mycin, ERYC, Erycette, Eryderm , Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm , Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab , Romycin, Staticin, T-Stat
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