Trachoma is most common in the poorer rural areas of Africa, Asia, Central and South America, Australia and the Middle East. In Australia, trachoma is almost exclusively found within the Indigenous population.

What is trachoma?

Trachoma is a chronic inflammation of the external lining tissue of the eye and eyelids (the conjunctiva). It is caused by infection with the microbe Chlamydia trachomatis.

Over a period of many years starting in early childhood, inflammation, which is the body's response to infection, causes the conjunctiva to become scarred and roughened. This interferes with its normal function which is to lubricate, protect and nourish the clear front tissue of the eye, the cornea. The cornea can be directly involved in the inflammation as well.

The cornea thus gradually becomes scarred itself, becoming hazy and irregular, and with abnormal blood vessels growing into it, reducing vision.

The cornea also becomes much more prone to other infections and has a reduced ability to respond to environmental damage or trauma. This whole process usually takes many years.

In the later or advanced stages of the condition, the eyelids may become so scarred that they turn inwards and the lashes then rub on the cornea (trichiasis). This is both painful and damaging to the cornea.

In this situation, an already damaged cornea is made rapidly worse. Without treatment, scarring and cloudiness of the cornea rapidly leads to blindness in that eye. Both eyes are usually affected so that the person becomes blind.

Blindness from trachoma is almost impossible to reverse and the eyes themselves are sometimes finally destroyed by secondary infection.

Who gets trachoma?

Trachoma is a disease of poverty and dispossession.

It occurs mainly in poor, overcrowded communities where the basic health hardware - running water, separate and appropriate sleeping space, and good sanitation - are lacking. Flies, smoke, dust and a lack of general personal hygiene are characteristics of communities with trachoma. These communities are said to have endemic trachoma.

Ongoing infection and re-infection seems to perpetuate the disease. Most of the cases of active infection occur in young children of about two or three years.The consequences of this active infection, in the form of scarring, persist and often worsen over years.

Women suffer much more frequently and severely from trachoma than men. This is because women are usually the carers of young children.

What is the burden from trachoma?

Trachoma is one of the main conditions causing blindness in the world today.

There may be as many as 84 million people worldwide who are affected in some way by trachoma - about 8 million of those are blind or visually disabled.

Blinding trachoma occurs mainly in poor, dry regions of Africa, in poor parts of the Middle East, in Myanmar and in parts of Indo-China. There are pockets of communities with blinding trachoma in many other parts of the world.

Some Indigenous communities in outback Australia still suffer from blinding trachoma as a result of poor living conditions.

Australia is the only developed nation still to have blinding trachoma. Trachoma lessens and disappears as communities emerge from poverty.

Can trachoma be treated?

Trachoma can be treated in its early stages but treatment becomes increasingly complex, difficult and unsuccessful in the more advanced stages of the disease.

For individuals with trachoma, treatment consists of antibiotic tablets or syrup in the active or childhood stages of the disease, surgery to scarred eyelids, antibiotic drops and ointments to treat secondary infections and possibly corneal grafting in desperate late cases.

Corneal grafting is rarely available to patients with blinding trachoma and the corneal grafts do not usually succeed.

Can trachoma be prevented?

The above SAFE strategy aims both to treat and to prevent trachoma. The key to prevention is to help communities emerge from poverty and dispossession.

Trachoma always disappears from communities when they go from poverty to even a reasonable level of prosperity. This seems to be mainly due to the breaking of the intense cycle of infection and re-infection which occurs in impoverished communities.

When communities are still living in poverty, data about the disease needs to be gathered and used to plan which communities need to have treatment with antibiotics and who is to receive it.

Cases of scarring of the eyelids need to be identified so that early corrective surgery is done to help prevent scarring of the cornea from worsening.

If trachoma starts to die out in a community, people with scarring from earlier times still need to be monitored to prevent this scarring of the cornea.

Note: This information is general in nature and is not a substitute for specialist medical advice. Have your eyes checked regularly every two years, even if you have not noticed any symptoms or changes.