What Is Trachoma Disease and How Does It Cause Blindness?

Learn about its causes and symptoms below - and our efforts to eliminate trachoma and trichiasis - particularly in Ethiopia where there is the highest burden.

Trachoma is a highly contagious bacterial infection of the outer eye often experienced in childhood (aged 1-9). Trachoma also affects more women than men, as traditional gender roles mean that women are still more likely to have a larger share of domestic work and child rearing responsibilities.

The disease was eliminated in most industrialized nations by the 1950s but is sadly still common in areas of the world where there is poor sanitation and lack of clean water. According to the Museum of Family History, trachoma was one of the main reasons immigrants were turned away from entering the United States at Ellis Island in the early parts of the 20th century.

Trachoma can lead to trachomatous trichiasis in the later stages of the infection. Trachomatous trichiasis can occur when repeated infections of the inner part of the upper eyelid cause the upper eyelid to turn inwards so that eyelashes scrape on the eyeball - resulting in excruciating pain and permanent scarring of the front of the eye (the cornea). If left untreated trachomatous trichiasis will lead to blindness in most cases.

According the World Health Organization there are 2.5 million people living with trachomatous trichiasis.

Bacterium known as chlamydia trachomatis is spread through contact with the eyes, eyelids, nose or throat secretions of those infected.

Means of transmission include handling contaminated items such as clothes and bedding as well as flies spreading the infection.

According to the World Health Organization (WHO) environmental risk factors or predisposing factors influencing the transmission of the disease include:

• inadequate hygiene
• crowded households
• inadequate access to water
• inadequate access to and use of sanitation

The signs of trachoma are classed into five stages. These are:

Stage 1: Trachomatous Inflammation - Follicular (TF)

At the beginning, five or more follicles — small bumps that contain lymphocytes, a type of white blood cell — are visible with magnification on the inner surface of your upper eyelid (conjunctiva).

Stage 2: Trachomatous Inflammation - Intense (TI)

The eye is now highly infectious and becomes irritated with a thickening or swelling of the upper eyelid.

Stage 3: Trachomatous Scarring (TS)

Repeated infections lead to scarring of the inner eyelid. The scars often appear as white lines when examined with magnification. The eyelid may become distorted and may turn in (entropion).

Stage 4: Trachomatous Trichiasis (TT)

The scarred inner lining of your eyelid continues to deform, causing eyelashes to turn in so that they rub on and scratch the transparent outer surface of the eye (cornea).

Stage 5: Corneal Opacity (CO)

The cornea becomes affected by an inflammation that is most commonly seen under your upper lid. Continual inflammation made worse by scratching from the in-turned lashes leads to clouding of the cornea.

The recommended global elimination strategy led by the World Health Organization is summarized by the acronym SAFE, which means Surgery for trachomatous trichiasis, Antibiotics to clear active chlamydia trachomatis infection, Facial cleanliness, and Environmental improvement to reduce transmission.

Surgery

In the advanced stages of the disease where the eyelashes grow inward rubbing the cornea, surgery is required. This involves correcting the position of the eyelid to prevent the eyelashes turning inward causing further damage to the cornea and preventing vision loss. They are called tarsal rotation surgeries.

In some cases, removal of the eyelashes (epilation) is required. However, this procedure may need to be done repeatedly. Other ways of removing the eyelashes include cryotherapy (freezing) and electrolysis.

Antibiotics

The antibiotic of choice for treating active trachoma is Azithromycin. For public health intervention in trachoma control and elimination, the dose of Azithromycin is based on measuring the height of patients. Children under the age of seven receive syrups while children above the age of seven and adults receive tablets.

The dose for children is 20 mg/kg in a single dose; adults receive a single dose of 1 g. This type of treatment is most effective in the early stages. Tetracycline eye ointment is also recommended.

The World Health Organization recommends giving antibiotics to an entire community when more than 5% of children between 5 and 9 years of age have been affected by trachoma to reduce further spreading.

In 2023, we celebrated delivering 100 million doses of the trachoma-fighting antibiotic azithromycin with the help of our partners across Ethiopia.

Facial Cleanliness

Promoting education and awareness of facial cleanliness and personal hygiene such as frequently washing parts of the face with soap and clean, running water will reduce the spread of trachoma.

Environmental Improvement

Building infrastructure such as clean water points and sanitary toilets can reduce the spread of infection.

Together with our wonderful partners like Sight Savers, UK Government's Department for International Development and THE END FUND we’ve already made great strides in tackling blinding trachoma.

We recently celebrated the fact that trachoma has decreased by 91% since 2002 in endemic areas. This is all thanks to the collaborative efforts of the eye health community and those who support it, helping get clean water and antibiotics to those at risk. Orbis initiatives to tackle trachoma include:

Training: We provide advanced training and mentorship to eye care teams in nearly every country in the world, empowering them to deliver sight-saving care where the need is greatest. Our specialist training is delivered in partnership with local hospitals, public health agencies and governments. It takes place on board our incredible Flying Eye Hospital, through our online mentoring platform, Cybersight, and through our long-term country programs. 

Technology: Through innovative technology like our award-winning telemedicine platform Cybersight, artificial intelligence diagnostic technology, virtual reality training, and the world’s first and only Flying Eye Hospital, we're revolutionizing ophthalmic training for eye care professionals and treatment for patients around the world.

Treatment and prevention: Through our long-term country programs we provide equitable access to quality eye care that transforms lives and communities. Orbis puts eye care within reach through programs that serve communities where they are. To reach the most underserved populations, quality care must be not only available, but also easily accessible. 

Teamwork: Through support from donors, corporate sponsors, employees, governments, and a team of more than 400 world-renowned medical volunteers, we work in collaboration with local partners to improve the quality and availability of eye care, ensuring our impact endures long term and becomes self-sustaining