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trachoma

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Definition
Trachoma is a highly contagious infection of the eyes. Trachoma is caused by an organism called Chlamydia trachomatis.

What is going on in the body? 
Trachoma is a form of an eye infection called conjunctivitis. The chlamydia organism infects the conjunctiva and cornea of the eye. It can cause a number of symptoms and serious complications. Chlamydia was once thought to be a virus but is now believed to be more bacterial. It appears to respond to antibiotics. The infection is chronic and long lasting. Trachoma usually infects only the eyes. But it can also settle in the urethra, the tube that carries urine from the bladder to the outside of the body.

What are the signs and symptoms of the disease? 
Symptoms of trachoma include the following:
  • redness of the eye
  • eye pain
  • tearing
  • sensitivity to light
  • scarring of the cornea
  • eyelid deformities
  • crooked eyelashes
  • scarring of the conjunctiva
What are the causes and risks of the disease? 
Trachoma is a chief cause of blindness in many areas of the world. Trachoma is most common in poor countries that lack clean water and adequate hygiene. It is sometimes transmitted by using washbasins and towels that others have used. Flies and other insects that come in contact with the eyes may also spread the organism.

Trachoma can be found along the Mediterranean Sea, in the Middle East, India, China, Mexico, Central America, Brazil, and Argentina. It also occurs in rural areas of Australia, especially in Aboriginals.

What can be done to prevent the disease? 
Trachoma can be nearly eliminated with good hygiene measures. Washing the face daily with clean water, soap, and using one's own towel can decrease the risk. It may also be helpful to keep gnats and flies away from the eyes.

How is the disease diagnosed? 
The doctor will do a complete history and physical examination, followed by an eye examination. A small spatula is used to collect material from the conjunctiva. If the Chlamydia trachomatis organism is found, the diagnosis is confirmed. In some cases, further tests must be done.

What are the long-term effects of the disease? 
If the condition is not treated, the cornea can become scarred over the pupil area, causing the following:
  • dry eyes
  • scar tissue formed by invasion of the upper cornea by small blood vessels
  • ptosis, or drooping of the upper eyelid
  • corneal ulcers and infections
  • partial loss of vision
  • blindness
What are the risks to others? 
Trachoma is spread by direct contact from one person to another. It can also be spread by contaminated water and items such as shared towels.

What are the treatments for the disease? 
Trachoma is usually treated with antibiotics given over 3 to 5 weeks. In areas with poor hygiene, little medical care and few antibiotics may be available. In this case, topical antibiotics can be used for mass treatment. People with trachoma often have a secondary bacterial infection, which also must be treated. Corrective surgery may be needed to prevent blindness. Vaccines offer only temporary and partial protection.

What are the side effects of the treatments? 
Antibiotics may cause stomach upset or allergic reactions. Surgery carries a risk of bleeding, infection, and allergic reaction to anaesthesia.

What happens after treatment for the disease? 
If trachoma is diagnosed early, treatment with antibiotics may control symptoms. For more extensive symptoms and disease, surgery may be necessary. Recovery from surgery may take a few days to several weeks.

How is the disease monitored? 
Depending on the cause, a person may be able to monitor trachoma at home. This condition may recur and require additional treatment. Any new or worsening symptoms should be reported to the doctor.

Author: William Stevens, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 15/03/2005
Contributors
Potential conflict of interest information for reviewers available on request
 


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