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Trachoma - including symptoms, treatment and prevention

Trachoma is a preventable disease of the eyes caused by infection with the bacteria Chlamydia trachomatis (different from the sexually transmitted form of this germ). It causes loss of vision and blindness in older people who have had severe active trachoma, usually since childhood.

The disease is present in over 40 countries where 1.9 million people have their vision damaged by the infection. Australia is the only developed country with blinding trachoma.

Aboriginal people in remote Australia are most at risk of developing trachoma, with young children the highest risk.  Trachoma is a common cause of blindness in Aboriginal adults.

Australia has signed the World Health Organization (WHO) agreement to eliminate blinding trachoma as a public health problem by 2020 and South Australia is on track reach this target.

How trachoma is spread

Trachoma occurs in areas with overcrowded housing where personal and community hygiene are difficult to maintain. The germ is easily spread through infected eye fluids. These fluids are passed back and forth between young children during close contact, such as playing and sharing the same bedding. Flies can also spread the germ.

Children are the main source (reservoir) of infection. Dirty faces are the most important risk factor in the spread of trachoma.

Signs and symptoms

Active trachoma in children often causes no symptoms. Trachoma can be present even in children with clean faces. However, children with active trachoma may have red, sore, sticky eyes and discharge from the nose.

The cycle of repeated active infection and resolution occurs over many years. As trachoma progresses in teenagers and young adults, scarring develops under the eyelids. Without treatment the eyelashes turn in and rub on the cornea (the clear part of the front of the eye). This is called trichiasis, and may be painful. Eventually this will cause scarring of the cornea, followed by loss of vision and blindness.

Incubation period

(time between becoming infected and developing symptoms)

Between 5 to 10 days, but most episodes of infection are reinfections and usually occur in children who already have the disease. Trichiasis usually takes many years to develop.

Infectious period

(time during which an infected person can infect others)

Between 2 to 3 months. Trachoma is very infectious in its early stage and may be infectious on and off as long as active infection persists.

Diagnosis

The diagnosis is made by qualified primary health care staff (Aboriginal health workers, nurses and doctors) taking a history and examining the eye. A swab of the eye may be used to help the diagnosis but is not routinely required

Treatment

  • A single dose of an antibiotic (azithromycin) is the recommended treatment for all people with active trachoma.
  • This antibiotic is also recommended for the contacts of the person being treated.  A contact is anyone who is living and/or sleeping in the same house as a person with trachoma.  If the person lives or sleeps in multiple households, then all members of each household are regarded as contacts. 
  • If there is a high rate of trachoma in a community, then all Aboriginal members of the community should be treated with this antibiotic.
  • Aboriginal adults over 40 years of age in communities where trachoma is usually present (endemic) should be screened annually for trichiasis. Adults who complain of a sore eye also need to be examined for trichiasis. Health services need to ensure timely treatment and referral to an eye surgeon for people with trichiasis.

Prevention

The WHO and the Communicable Disease Network Australia recommend the SAFE strategy, 4 actions which aim to eliminate trachoma:

  • Surgery for trichiasis
  • Antibiotics (azithromycin) for cases of active trachoma and their contacts
  • Facial cleanliness by promoting clean faces to reduce spread of infection
  • Environmental improvements to improve overcrowding, water and sanitation facilities.

Useful links

Acknowledgement

Information modified and reproduced with kind permission from Northern Territory Centre for Disease Control. Trachoma Factsheet for patients and health professions

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