What Is Trachoma Disease and How Does It Cause Blindness?

Learn about its causes & 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 eradicated 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 off 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.

In order to succeed Orbis has adopted the World Health Organisations SAFE strategy which is vital for the social and economic growth of this region.

SAFE, which means Surgery for Trachomatous Trichiasis, Antibiotics to clear active chlamydia trachomatis infection, Facial cleanliness and Environmental improvement to reduce transmission.

Orbis plans to leave this region with the knowledge and skills so they can thrive independently and allow future generations to grow up free from the threat of blindness.

MASS DRUG ADMINISTRATION

Since 2008 our local partnerships in Ethiopia resulted in more than 44.5 million doses of antibiotics to treat and prevent trachoma. Our success is testament to the strong alliances we’ve forged with hospitals and other healthcare partners.

BUILDING A FRONTLINE

In Ethiopia we're training nurses to perform trichiasis surgeries at primary healthcare units and building awareness of the infection by teaching community health workers, health extension workers, teachers, local women’s group leaders and community leaders about eye health. During Mass Drug Administration programs, the team recruit and train hundreds of volunteers from local communities, clinics and government-trained healthcare professionals.

While fighting trachoma is a major focus for Orbis, it is not tackled on its own. We tackle all major causes of avoidable blindness through a comprehensive approach to eye care. While we fight trachoma, we are also fighting cataract, glaucoma, diabetic retinopathy and retinopathy of prematurity at the same time.

EDUCATING COMMUNITIES

A vital part of our work is educating communities and school children about eye health. In 2018, we distributed the illustrated storybook The Singing Tree in Amharic to 5,000 school eye health clubs and children in Ethiopia for free, to encourage educators, parents and children to seek help when they identify vision problems.

Dedicated eye care clubs across secondary schools in Gamo Gofa, Ethiopia, for example allow students to learn how to take good care of their eyes and what to do if their vision begins to deteriorate. The clubs also illustrate the importance of hygiene for good eye care and the prevention of trachoma.

DEVELOPING EYE CARE IN RURAL AREAS

80.5% of Ethiopia’s population live rurally and have limited access to healthcare. We’ve developed comprehensive rural eye care programs to complement trachoma outreach efforts; focusing on the elimination of trachoma using the WHO-recommended SAFE strategy. In rural areas, we've also helped set up water points so families don't need to walk miles to get to their nearest source, such as the local river where dirty water increases the risk of trachoma infection.

ELIMINATING TRACHOMA

As we've learned already, trachoma is one of the leading causes of avoidable blindness worldwide, affecting millions of people in some of the world's poorest communities. But with the right investment and planning, this terrible condition can not only be treated, it can be eliminated for good.

Donate today to help Orbis and our partners rid the world of this terrible eye disease.