Trachoma
Granular conjunctivitis; Egyptian ophthalmia; Conjunctivitis - granular; Conjunctivitis - chlamydia
Trachoma is an infection of the eye caused by bacteria called chlamydia.
The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.
Causes
Trachoma is caused by infection with the bacteria Chlamydia trachomatis.
The condition occurs around the world. It is most often seen in rural areas of developing countries. Children are often affected. However, the scarring caused by the infection may not be noticed until later in life. The condition is rare in the United States. However, it is more likely to occur in crowded or unclean living conditions.
The bacteria that cause trachoma are spread through direct contact with infected eye, nose, or throat fluids. They can also be passed by contact with contaminated objects, such as towels or clothes. Certain flies can also spread the bacteria.
Symptoms
Symptoms begin 5 to 12 days after being exposed to the bacteria. The condition begins slowly. It first appears as inflammation of the tissue lining the eyelids (conjunctivitis, or "pink eye"). Untreated, this may lead to scarring.
Symptoms may include:
- Cloudy cornea
- Discharge from the eye
- Swelling of lymph nodes just in front of the ears
- Swollen eyelids
- Turned-in eyelashes
Exams and Tests
The health care provider will do an eye exam to look for scarring on the inside of the upper eye lid, redness of the white part of the eyes, and new blood vessel growth into the cornea.
Lab tests are needed to identify the bacteria and make an accurate diagnosis.
Treatment
Antibiotics can prevent long-term complications if used early in the infection. In certain cases, eyelid surgery may be needed to prevent long-term scarring, which can lead to blindness if not corrected.
Outlook (Prognosis)
Outcomes are very good if treatment is started early before scarring and changes to the eyelids develop.
Possible Complications
If the eyelids become very irritated, the eyelashes may turn in and rub against the cornea. This can cause corneal ulcers, additional scars, vision loss, and possibly, blindness.
When to Contact a Medical Professional
Contact your provider if you or your child recently visited an area where trachoma is common and you notice symptoms of conjunctivitis.
Prevention
Spread of the infection can be limited by washing your hands and face often, keeping clothes clean, and not sharing items such as towels.
References
Batteiger BE, Tan M. Chlamydia trachomatis (trachoma and urogenital infections). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 180.
Bhatt A. Ocular infections. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 61.
Hammerschlag MR. Chlamydia trachomatis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 253.
Ramadhani AM, Derrick T, Macleod D, et al. Ocular immune responses, chlamydia trachomatis infection and clinical signs of trachoma before and after azithromycin mass drug administration in a treatment naïve trachoma-endemic Tanzanian community. PLoS Negl Trop Dis. 2019;13(7):e0007559. PMID: 31306419
Rubenstein JB, Spektor T. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.6.
Sata E, Nute AW, Astale T, et al. Twelve-year longitudinal trends in trachoma prevalence among children aged 1-9 years in Amhara, Ethiopia, 2007-2019. Am J Trop Med Hyg. 2021;104(4):1278-1289. PMID: 33534757
Version Info
Last reviewed on: 8/22/2022
Reviewed by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
