Comprehensive Wellness Guide to Understanding and Managing Trachoma

Trachoma is the world’s leading infectious cause of blindness, affecting over 137 million people in 42 endemic countries. Caused by Chlamydia trachomatis, repeated infections scar the eyelids, turning lashes inward (trichiasis) and scratching the cornea. In Trachoma 101, we explore the science behind this preventable disease, its causes, symptoms, treatments, and the WHO-endorsed SAFE strategy for elimination in 2025. This guide offers practical, evidence-based solutions for communities, healthcare workers, and global health advocates.

What Is Trachoma?

Trachoma is a contagious bacterial eye infection that progresses from inflammation to scarring and blindness if untreated. It spreads through eye discharge, hands, clothing, and flies. The WHO classifies trachoma in five stages, with trichiasis (TT) and corneal opacity (CO) leading to irreversible vision loss. The SAFE strategy—Surgery, Antibiotics, Facial cleanliness, Environmental improvement—has eliminated trachoma in 17 countries since 2011.

Introduction: Why Trachoma Matters

Trachoma thrives in poverty, overcrowding, and poor sanitation, disproportionately affecting women and children in rural areas. The WHO targets global elimination by 2030. Advances in mass drug administration (MDA), surgery, and hygiene education are accelerating progress. This guide provides actionable insights to understand trachoma, implement SAFE, and promote eye health while addressing social determinants.

Stages of Trachoma

Trachoma progresses through five WHO-defined stages:

• Trachomatous Inflammation—Follicular (TF): Active infection with follicles on the conjunctiva; seen in children.
• Trachomatous Inflammation—Intense (TI): Severe inflammation; highly contagious.
• Trachomatous Scarring (TS): Scar tissue forms on the inner eyelid.
• Trachomatous Trichiasis (TT): Eyelashes turn inward, scratching the cornea.
• Corneal Opacity (CO): Scarring clouds the cornea, causing blindness.

Causes and Risk Factors of Trachoma

Trachoma is caused by Chlamydia trachomatis serotypes A, B, Ba, and C. Key risk factors include:

• Poor Hygiene: Lack of facial cleanliness and handwashing spreads infection.
• Fly Exposure: Eye-seeking flies transmit bacteria from discharge.
• Overcrowding: Close contact in households increases transmission.
• Water Scarcity: Limited water for washing faces and hands.
• Age & Gender: Children (1–9 years) and women (caregivers) are most affected.

Trachoma Triggers to Watch For

Environmental and behavioral factors fuel transmission:

• Dirty Faces: Discharge attracts flies and spreads bacteria.
• Shared Towels/Clothing: Contaminated fabrics transmit infection.
• Fly Breeding Sites: Open latrines and garbage near homes.
• Dry Seasons: Dust irritates eyes, worsening inflammation.
• Lack of Latrines: Open defecation increases fly populations.

Treatment Options for Trachoma

Treatment follows the SAFE strategy:

S – Surgery

• Bilamellar Tarsal Rotation: Corrects trichiasis; 80–90% success rate.

A – Antibiotics

• Azithromycin (Zithromax): Single-dose oral; preferred for MDA.
• Tetracycline Eye Ointment: Twice daily for 6 weeks in non-MDA settings.

F – Facial Cleanliness

• Daily face washing with soap reduces active trachoma by 50%.

E – Environmental Improvement

• Latrines, water access, fly control (insecticide spraying).

Actionable Tip: Prioritize azithromycin MDA in districts with TF >10% in children.

Management Routine for Trachoma

Community-based routines sustain elimination:

1. Annual MDA: Azithromycin distribution in endemic areas.
2. Face Washing: Teach children to wash faces twice daily.
3. Trichiasis Screening: Train community workers to identify TT cases.
4. Hygiene Education: Weekly school and household sessions.
5. Environmental Audits: Monitor latrine use and water points monthly.
6. Surveillance: WHO trachoma impact surveys every 2–3 years.

Management Tips

• Use pictorial hygiene posters in local languages.
• Integrate trachoma control with WASH programs.
• Train “eye ambassadors” in villages for peer education.
• Track surgery outcomes with mobile apps.

SAFE Component	Purpose	Recommended Frequency
Surgery	Corrects trichiasis	As needed
Antibiotics	Clears infection	Annually (MDA)
Facial Cleanliness	Reduces transmission	Daily

Lifestyle Changes to Support Trachoma Elimination

Community habits prevent recurrence:

1. Hygiene Promotion

• Wash faces with soap and clean water twice daily.
• Use individual towels; avoid sharing.

2. Environmental Sanitation

• Build and use pit latrines with fly-proof lids.
• Dispose of animal waste far from homes.

3. Fly Control

• Install fly traps or screens on windows.
• Cover food and clean cooking areas.

4. Water Access

• Ensure >500 meters proximity to clean water sources.
• Use tippy-taps for handwashing stations.

Actionable Tip: Combine “F” and “E” for maximum impact—clean faces and clean environments.

Emotional and Mental Wellness

Trachoma-related blindness causes isolation and stigma. Support with:

• Community Inclusion: Integrate visually impaired in village activities.
• Peer Support Groups: For TT patients awaiting surgery.
• Education: Reduce stigma through awareness campaigns.
• Rehabilitation: Provide mobility training and income opportunities.

Preventing Trachoma Complications

Avoid blindness and corneal damage by:

• Screening children annually for TF/TI.
• Offering surgery within 6 months of TT diagnosis.
• Distributing azithromycin before scarring begins.
• Improving WASH infrastructure sustainably.

When to See a Doctor

Seek care for:

• Red, itchy, or gritty eyes in children.
• Discharge or swollen eyelids.
• In-turned eyelashes touching the eyeball.
• Cloudy cornea or vision loss.

Diagnosis: Clinical exam with eyelid eversion; no lab tests needed in endemic areas.

Myths About Trachoma

Debunking misconceptions aids control:

• Myth: Trachoma is genetic. It’s bacterial and preventable.
• Myth: Only dirty people get it. Anyone in endemic areas is at risk.
• Myth: Surgery is dangerous. TT surgery has <1% complication rate.
• Myth: Antibiotics alone eliminate trachoma. SAFE requires all four components.

Holistic Approach to Trachoma Elimination

Integrate medical, behavioral, and environmental strategies:

• Implement SAFE Fully: No component works in isolation.
• Engage Communities: Local ownership ensures sustainability.
• Monitor Progress: Use WHO indicators for validation.
• Advocate Globally: Support funding for MDA and WASH.

Conclusion

Trachoma is entirely preventable and eliminable with the SAFE strategy. From azithromycin distribution to latrine construction, every action counts. By combining medical treatment with hygiene education, environmental improvements, and community empowerment, we can end trachoma blindness by 2030. Embrace these science-backed strategies in 2025 to protect vision and transform lives.