Trachoma – Symptoms and Causes
Overview
Trachoma is a bacterial eye infection caused by Chlamydia trachomatis. This highly contagious disease spreads through direct contact with infected eyes, eyelids, and secretions from the nose or throat of infected individuals.
People can also contract trachoma by touching contaminated items like handkerchiefs.
The infection typically begins with mild symptoms such as eye irritation and itching. As it progresses, patients may experience swollen eyelids and eye discharge. Without proper treatment, trachoma can eventually cause blindness.
Globally, trachoma remains the leading cause of preventable blindness. The disease disproportionately affects impoverished regions, with Africa bearing the heaviest burden—approximately 85% of active cases occur there.
Children under five are particularly vulnerable, with infection rates exceeding 60% in highly affected areas.
Key Facts About Trachoma:
- Caused by: Chlamydia trachomatis bacteria
- Transmission: Direct contact with infected secretions
- Common symptoms: Eye irritation, swelling, discharge
- Primary prevention: Early treatment and improved hygiene
Signs and Symptoms
Trachoma affects both eyes and includes several uncomfortable effects. These may involve:
- Mild eye and eyelid itching and irritation
- Mucus or pus discharge from eyes
- Swollen eyelids
- Sensitivity to light
- Pain in the eyes
- Redness around the eyes
- Loss of vision
Children face a higher risk of getting infected, but the disease develops slowly. The more painful symptoms might not appear until adulthood.
Trachoma develops through five main stages:
- Early Inflammation with Follicles: Small bumps containing white blood cells appear on the inner surface of the upper eyelid.
- Intense Inflammation: The eye becomes highly contagious with noticeable swelling of the upper eyelid.
- Scarring of the Eyelid: Repeated infections cause scarring that looks like white lines when magnified.
- Inward-Turning Eyelashes: Scarring continues, causing eyelashes to turn inward and rub against the cornea.
- Cloudy Cornea: Ongoing inflammation and scratching from the turned-in eyelashes lead to corneal clouding.
The upper eyelid shows more severe signs than the lower eyelid. Without treatment, this disease can progress from childhood into adulthood.
When To Get Medical Help
Contact your doctor if you or your child experiences itchy or irritated eyes or has discharge coming from the eyes. This is especially important if you live in or recently visited an area where trachoma is common.
Since trachoma spreads easily from person to person, early treatment helps prevent serious infection and complications.
Look for medical care if you notice any changes in vision or increasing discomfort in the eyes. Quick action can prevent the disease from progressing to its more serious stages where permanent vision damage becomes more likely.
Causes
Trachoma develops from specific types of the bacterium Chlamydia trachomatis. This is related to the bacteria that causes the STI chlamydia, but it affects different parts of the body.
The infection spreads through direct or indirect contact with an infected person’s eye or nose discharge. Several transmission routes exist:
- Physical contact with contaminated hands
- Shared items like towels and clothing
- Insects, particularly flies that land on faces
- Household contact with infected individuals
In regions with limited sanitation, face-seeking flies often carry bacteria between people, spreading the infection throughout communities.
Risk Factors
Several factors can increase the chance of getting trachoma:
- Crowded living conditions where people live close together, making it easier for the infection to spread.
- Poor hygiene and sanitation, including limited access to clean water and unwashed faces or hands.
- Age, with children between 4-6 years old having the highest risk in affected areas.
- Gender differences, as women may be 2-6 times more likely to get infected than men, possibly because they spend more time caring for children.
- Presence of flies in the environment, as these insects can help spread the infection.
The disease spreads more easily when people live in areas with poor waste management, limited clean water, and inadequate personal hygiene practices. Children often serve as the main source of infection in communities where trachoma is common.
Complications
If left untreated, a single trachoma infection can develop gradually into more serious problems. Repeated infections with the bacteria that causes trachoma may lead to several complications:
- Scarring inside the eyelid
- Eyelid turning inward (entropion)
- Eyelashes growing toward the eye (trichiasis), scratching the cornea
- Cloudy or scarred cornea
- Vision impairment or blindness
Prevention
Trachoma is preventable through proper hygiene and community health measures. It’s more common in regions of Africa, Asia, Latin America, the Middle East, and the Pacific Rim. When traveling to these areas, taking extra precautions with hygiene is essential.
Good hygiene practices that help prevent trachoma include:
- Regular Face and Hand Washing: Keeping faces clean breaks the infection cycle.
- Controlling Fly Populations: Reduces a key transmission source.
- Proper Waste Management: Disposing of human and animal waste correctly limits fly breeding areas.
- Access To Clean Water: Having nearby freshwater improves overall hygiene.
The World Health Organization developed a strategy called SAFE to combat trachoma:
| SAFE Strategy | Description |
|---|---|
| Surgery | Treats advanced trachoma cases |
| Antibiotics | Treats and prevents infection |
| Facial cleanliness | Promotes regular face washing |
| Environmental improvements | Enhances water access, sanitation, and fly control |
This strategy has significantly reduced global trachoma cases, though it hasn’t completely eliminated the disease as originally hoped.
If you’ve already been treated for trachoma with antibiotics or surgery, reinfection remains a concern. Make sure all household members get screened and treated if necessary to protect yourself and others.
No trachoma vaccine exists, making prevention through hygiene and community health measures crucial for controlling this disease.
