What is trachoma?

Trachoma is a treatable and preventable eye infection caused by the bacterium chlamydia trachomatis.

The bacterial infection starts on the inner surface of the eyeball. If you are infected repeatedly, you may get scarring that causes this surface to become rough and thicken.

Infection can cause your eyelids to turn inwards, causing trichiasis. This is when your eyelashes rub on your eyeball, causing pain and damaging the surface of your eye. Repeated infections can cause blindness.

Australia is the only developed country with blinding trachoma. Aboriginal and/or Torres Strait Islander people in remote areas of Australia are at highest risk.

What are the symptoms of trachoma?

If you're infected with trachoma, your eyes might be:

• red
• sticky
• itchy
• painful
• watery

You might also have discharge from your eyes or nose. In later stages, you might feel a gritty sensation, as if you have sand in your eyes. You will usually experience symptoms 5 to 15 days after you were in contact with an infected person.

Often, children with trachoma don't have symptoms.

Trachoma is most common in small children but scarring and in-turned eyelashes (trichiasis) are usually found in older people. Scarring can cause the eye to look white or milky. Trichiasis is irreversible.

What causes trachoma?

The bacteria that cause trachoma are spread through direct contact with fluid from the eyes and nose of infected people. The chlamydia trachomatis bacteria that usually causes trachoma is a different strain (sub-type of bacteria) from the common sexually transmitted infection chlamydia. Rarely, you can get an eye infection from sexually transmitted chlamydia called chlamydial conjunctivitis.

If you are infected, the contagious period can last between 2 to 3 months, or for as long as the active infection exists.

Ways that the bacteria can be spread include through:

• personal items such as face cloths
• flies that touch infected eyes
• unwashed hands
• close contact with an infected person

As trachoma is easily transmitted between children, the condition often starts in childhood, but anybody can get infected at any age. People who have repeated infections since childhood may develop visual impairment or blindness, usually in their 30s or 40s.

What living conditions are linked to increased risk of trachoma?

Trachoma is more common in areas where a lot of people live close together. It is especially common in places with poor hygiene, due to limited access to water and poor toilet facilities.

When should I see my doctor?

You should see your doctor if:

• your eyes hurt
• you need to pluck your eyelashes
• you can't see well

How is trachoma diagnosed?

Your doctor can diagnose trachoma by talking to you and examining your eyes. If you have an active trachoma infection, you may have pale round spots (follicles) on the inner side of your eyelid.

Your doctor may also take a swab of fluid from your eyes to test for bacteria.

How is trachoma treated?

Active trachoma is treated with a single dose of an antibiotic called azithromycin. Your household contacts should also be treated. If you have trichiasis, your doctor may refer you to an eye surgeon to correct the turning in of your eyelid.

If trachoma is widespread in your community, everyone may receive antibiotic treatment.

What are the complications of trachoma?

Repeated trachoma infections can scar the lining of your eyeball. Scarring can make your eyelid turn inwards over time, known as trichiasis. This causes your eyelashes to rub on the eyeball, which is painful and causes further scarring. Even one eyelash rubbing on your eye can cause more scarring.

If your trichiasis is not treated with surgery, or if you are infected many times, this scarring can lead to blindness.

Can trachoma be prevented?

Trachoma is generally associated with poor hygiene. Simple steps to improve hygiene can be very effective, such as:

• teaching children good hygiene
• making sure family members don't share towels and face cloths
• washing your hands and face regularly
• keeping your environment clean and free from flies
• taking care of your eyes

Improving access to clean water, better sanitation and reducing overcrowding can help stop trachoma from spreading.

The World Health Organisation and the Communicable Disease Network Australia developed the SAFE strategy to end trachoma infections:

• S — surgery to treat trichiasis
• A — antibiotics for infected people and their contacts
• F — facial cleanliness to reduce infection
• E — environmental improvements to improve hygiene

Some Aboriginal and/or Torres Strait Islander communities have high rates of trachoma. Adults in communities where trachoma is common should be screened for trichiasis every year.

Resources and support

For more information on trachoma, you can contact your:

• local doctor
• optometrist
• ophthalmologist (eye doctor)

Visit Optometry Australia to find an optometrist.

Call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Looking for information for Aboriginal and/or Torres Strait Islander communities?

Find an Aboriginal Community Controlled Health Organisation or Affiliate near you.

These helpful resources are available from the University of Melbourne's Indigenous Eye Health Unit:

• Clean Faces, Strong Eyes campaign
• Milpa's Six Steps to Stop Germs poster for children