Eyes Trachoma

Overview

Trachoma is an eye infection caused by a common type of bacteria (germ). It spreads easily from eye to eye, especially between young children, through hands, towels, bedding and flies. A single infection usually clears up with treatment and does little harm. The problem comes when people get infected again and again over many years. Each round of infection leaves a little scarring on the inside of the eyelid. Eventually the eyelid can shrink and curl inward, so the eyelashes scrape against the clear front surface of the eye (the cornea). That scraping causes pain, damage and, over time, permanent vision loss or blindness. The good news is that trachoma can be prevented, treated and even wiped out in communities with simple public health steps.

Trachoma was once common in many parts of the world, including parts of Europe and North America, but it has largely disappeared where clean water, sanitation and hygiene are reliable. Today it is found mainly in poor, rural communities in parts of Africa, Asia, the Middle East, Latin America and the Pacific. The World Health Organization reports that many countries have eliminated it as a public health problem, but it still affects millions of people in the remaining areas.

Trachoma is most often spread among young children, who carry the bacteria in their eyes and noses and pass it to each other while playing. Adults who care for children, most often women, are repeatedly exposed and are therefore more likely to develop the scarring and blindness that come later in life. It is linked to poverty: it thrives where water is scarce, where there are no proper toilets, where households are crowded, and where flies are plentiful.

Symptoms

Common symptoms

• Mild redness and irritation of the eye or eyes
• A sticky or watery discharge from the eye
• Swollen eyelids and a gritty feeling, like something is in the eye
• Sensitivity to light
• Later on: a feeling of scratching or scraping in the eye as eyelashes begin to turn inward
• Later on: blurred vision or a gradual loss of sight

Symptoms in children

• Trachoma is most active in children, especially those under 10 years old
• Red, irritated eyes with discharge, often mild enough that a child does not complain
• Symptoms may come and go and may clear without treatment, but each episode adds to the damage
• Children with frequent eye infections should be checked, because repeated infection is what causes lasting harm

Symptoms in older adults

• The inner eyelid may become thick and scarred
• Eyelashes may turn inward and rub against the eye (trichiasis), which is painful
• The eyelid edge may curl inward (entropion)
• The clear front of the eye (cornea) may become cloudy, causing permanent vision loss
• The eye may be more easily infected or injured

Causes

Main causes

• Infection with a bacterium called Chlamydia trachomatis, which lives in the eye and nose
• Spread by direct contact: fingers, towels, cloths, bedding and shared face-washing water
• Spread by flies that feed on eye and nose discharge and then land on another person's face
• Repeated infections over years are what cause the scarring and sight loss

Risk factors

• Not having enough clean water for washing
• Poor sanitation and open toilets or no toilets
• Crowded homes with many children close together
• Lots of flies, especially in warm, dusty places
• Being a young child, since children are the main carriers of the infection
• Being a woman or girl who cares for young children, which means more exposure
• Living in a community where trachoma is known to be present
• Poverty and limited access to healthcare

When to see a doctor

See a doctor urgently if:

• You can see or feel eyelashes touching your eye, or your eye is painful
• Your vision has changed quickly
• There is a lot of discharge, or the eye is very red and swollen
• You have been told you have trachoma and your symptoms are getting worse

Book a routine appointment if:

• You have repeated or long-lasting eye redness or discharge
• You live in or have travelled to an area where trachoma is common and you have eye symptoms
• Your eyelids look thickened or your lid margins are turning inward
• You have a family member with trachoma and want to be checked

Diagnosis

A doctor, nurse or eye health worker can usually diagnose trachoma by looking closely at your eyes. They will examine your eyelids, including turning the upper eyelid gently outward to look at the inside surface where the scarring and lashes begin. In areas where trachoma is common, health workers use a simple set of standard signs to grade how serious it is. This helps decide who needs treatment or surgery.

Tests that may be done

• An eye examination with a magnifier and a bright light
• Careful inspection of the inner surface of the upper eyelid, using a small swab or gentle pressure to turn the lid
• Checking the cornea (the clear front of the eye) for damage or clouding
• Checking whether eyelashes are touching the eyeball
• Occasionally, a swab test of the eye discharge to confirm the bacteria, usually for public health surveys rather than individual care
• A vision check

What to expect at your appointment

The examination is quick and usually painless. Turning the eyelid over can feel strange for a second but does not hurt. You may be asked about your home, water supply and whether others in your household have eye problems, because trachoma runs in families and communities. If you need treatment, most people are given it the same day, and if you need eyelid surgery, you will be told what is involved and where it can be done.

Treatment

Treatment depends on which stage of trachoma you have. Active infection is treated with antibiotics that kill the bacteria. Scarring that has already happened cannot be undone, but if eyelashes are rubbing on the eye, a small operation can turn the eyelid back to a normal position and protect your sight. In communities where trachoma is common, whole villages or districts are sometimes treated together, along with hygiene and water improvements, because that is the most effective way to stop the infection spreading. Your healthcare provider will talk you through what is right for you.

Self-care at home

• Wash your face and your children's faces with clean water every day, especially around the eyes and nose
• Wash hands with soap before touching your eyes and after caring for children
• Do not share towels, cloths or face-washing water with others
• Keep flies away from the face and from food; use covers and keep animals away from living areas
• Do not rub your eyes, since this can make scratching from eyelashes worse
• A clean, cool cloth over closed eyes can ease irritation
• If you have been given treatment, finish the full course and go to all follow-up appointments
• Take extra care of your general health, since other eye infections are more likely when the eye surface is damaged

Medical treatments

Active trachoma is treated with antibiotics, given either as eye ointment or as tablets, prescribed by a trained health worker. In areas where trachoma is widespread, a whole community may be offered treatment at the same time to reduce the spread of infection. Health teams also give advice on face washing and sanitation. Because trachoma is caused by bacteria, the choice of antibiotic, the dose and the length of treatment should always come from your healthcare provider.

When is surgery considered?

Surgery is needed when the eyelid has turned inward and eyelashes are rubbing against the eye. The operation is called trichiasis surgery. It is a short procedure, usually done with local anaesthetic so you stay awake but feel no pain. The surgeon makes a small cut in the eyelid and turns the lid edge back outward, so the lashes point away from the eye again. Many people notice relief from the scratching straight away. The surgery cannot bring back sight already lost, but it protects the eye from further damage. Follow-up checks are important, as lashes can turn inward again over time.

Living with this condition

Living with trachoma usually means two things: protecting your eyes from further infection and damage, and getting regular eye checks if you have scarring. If you have had eyelid surgery, keep the area clean and attend your follow-up visits. If your vision is reduced, ask about low-vision support such as magnifiers, good lighting, and help with reading or work. Many people find that simple habits like daily face washing for the whole family, keeping flies away, and safe water storage make a big difference.

Lifestyle tips

• Make face washing part of the daily routine for everyone in the household
• Store water in clean, covered containers and use a tap or a ladle rather than dipping hands in
• Build and use a toilet if possible, and keep the area around the home clean
• Dry washed clothes and bedding in the sun and do not share them when someone has an eye infection
• Wear a hat or sunglasses in dusty, windy conditions to protect irritated eyes
• Avoid smoke from cooking fires and cigarettes, which irritates eyes
• Attend community screening or eye clinics when they visit your area

Diet and exercise

No special diet treats trachoma, but good general health helps your eyes heal and cope. Eating a varied diet with plenty of fruit and vegetables, including those rich in vitamin A such as carrots, sweet potato and dark green leaves, supports eye health. Keep active in whatever way suits you, and avoid dusty or smoky places when you can. If you smoke, giving up is one of the best things you can do for your eyes and your general health.

Mental health and emotional wellbeing

Losing part of your sight can be frightening and can bring sadness, worry or a sense of isolation. This is common and it is not a sign of weakness. Vision problems can also affect work, school, and caring for family, which adds stress. Talking to someone you trust, a health worker or a counsellor can help. If you feel very low, hopeless, or are having thoughts of harming yourself, please reach out to a local health service or crisis line straight away and tell someone you trust.

Prevention

Yes. Trachoma is one of the most preventable causes of blindness. Public health programmes use a package of measures known as the SAFE approach: Surgery for inward-turning eyelashes, Antibiotics to clear infection, Facial cleanliness (washing faces, especially children's), and Environmental improvement (clean water, safe toilets, fly control, less crowding). At home, the most powerful habit is simple: wash faces with clean water every day.

Vaccines

There is currently no vaccine that prevents trachoma. Prevention relies on hygiene, clean water, sanitation, fly control, community antibiotic treatment programmes and surgery when needed.

Screening programmes

In areas where trachoma is common, health programmes carry out regular community surveys and screening, often checking children's eyes and adults' eyelids. If you live in or have moved from such an area, ask your local health service whether an eye check is recommended. In places where trachoma is rare, screening is not routine, and you should simply see a doctor if you have eye symptoms.

Complications

If left untreated

• Repeated infection causes permanent scarring of the inner eyelid
• Eyelashes turn inward and scrape the surface of the eye (trichiasis), which is painful
• Scratches on the clear front of the eye (the cornea) can become infected and form ulcers
• The cornea can become cloudy and scarred, leading to permanent vision loss
• Blindness, which affects work, schooling and independence
• Added strain on families and communities, and in many places a link with poverty

Long-term outlook

The outlook is genuinely encouraging. Early infection is easily cleared with antibiotics, and eyelid surgery reliably stops eyelashes from damaging the eye. Because the world has committed to eliminating trachoma, many communities that once lived with it now no longer see new cases. If you have already lost some sight, it is still worth getting checked, because further damage can often be prevented and low-vision support can help you make the most of the sight you have.

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