Trachoma

Trachoma is an eye infection caused by a tiny bacterium called Chlamydia trachomatis. Repeated infections over many years make the inside of the eyelids rough and scarred. The eyelashes can then turn inward and scrape the clear front window of the eye (the cornea). This scratching is very painful and may cause permanent scarring and blindness if it is not treated. The infection spreads easily from person to person, especially among children, through hands, shared towels or cloths, and by eye-seeking flies. Communities without reliable water, sanitation, and waste disposal are hit hardest. The World Health Organization (WHO) recommends the SAFE strategy—Surgery, Antibiotics, Facial cleanliness, and Environmental improvement—to stop blindness from trachoma and to eliminate it as a public-health problem. World Health Organization+1

Trachoma is caused by certain types (serovars A, B, Ba, and C) of the bacterium Chlamydia trachomatis. After the first infection, the eyelids become red and bumpy (follicles). If infections keep happening over months and years, scar tissue forms inside the upper eyelid. This scarring slowly rolls the eyelid inward (entropion), so the lashes rub on the cornea (trichiasis). The constant rubbing creates painful scratches and white scars on the cornea, which can block vision like frost on glass. Without treatment, this damage can lead to low vision or blindness. NCBI

Trachoma is an eye infection. The infection is caused by a tiny germ called Chlamydia trachomatis. This germ is a type of bacteria. The germ likes to live in the thin, wet skin that covers the white of the eye and the inside of the eyelids. This skin is called the conjunctiva. The germ spreads from person to person. It spreads by direct touch of eye discharge. It also spreads by sharing cloths, towels, pillows, and hands that have eye discharge on them. It can also spread by eye-seeking flies that land on the face.

Trachoma often starts in childhood. The infection can come again and again. Many repeated infections cause long-term damage. The inside of the eyelid forms scars. Scars are hard lines of healed tissue. The scars can pull the eyelid inward. When the lid turns in, the eyelashes rub on the clear front window of the eye. This clear window is the cornea. The rubbing makes scratches and open wounds on the cornea. The cornea then turns cloudy. Cloudy cornea blocks light. This can cause vision loss. In severe cases, this can cause blindness.

Trachoma is common in places with poverty. It is common where there is little clean water. It is common where there is poor sanitation. It is common where many people live close together. Children and their caregivers often get it first. Women can be affected more than men because they care for small children who have eye discharge.

Trachoma is preventable. It is also treatable. But early detection is important. Clean faces, clean hands, safe water, and good toilets reduce spread. Early treatment helps stop scarring. Surgery can fix turned-in eyelashes. Public health teams use a package called “SAFE.” S is for Surgery for eyelashes that rub the eye. A is for Antibiotics to kill the germ. F is for Facial cleanliness. E is for Environmental improvement. This guide focuses on understanding the disease, its types, causes, symptoms, and tests.

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Types

Doctors often describe trachoma using stages. The stages match how the disease looks and how severe it is. The World Health Organization (WHO) grading is often used. The letters are simple codes. I will explain each code.

1) TF – Trachomatous Inflammation, Follicular (active early stage).
“Follicular” means there are small round bumps inside the upper eyelid. These bumps are tiny immune reaction spots. They look like small, pale, raised dots. The eye is often red and watery. This stage is common in young children. It shows recent or current infection.

2) TI – Trachomatous Inflammation, Intense (more active swelling).
“Intense” means there is stronger swelling. The inside of the eyelid looks thick and red. Blood vessels are hard to see because of the swelling. The eye may be very irritated. There is often sticky discharge. This stage can cause more damage if it happens again and again.

3) TS – Trachomatous Scarring (healed but stiff tissue inside the lid).
“Scarring” means hard lines have formed on the inner eyelid. These lines are marks of past disease. They change the shape and movement of the lid. The lid may start to turn in. The eye may feel dry because the inner surface does not move well.

4) TT – Trachomatous Trichiasis (lashes turn inward and scrape the eye).
“Trichiasis” means misdirected eyelashes. The lashes point inward. The lashes rub the cornea with every blink. This causes pain, tearing, and scratches. This needs quick care. Lashes can be removed or surgery can fix the lid position.

5) CO – Corneal Opacity (cloudy cornea after many injuries).
“Opacity” means the cornea is not clear. It is cloudy or white. This happens after long-term rubbing and infection. Light cannot pass well. Vision can be poor. This is a late and serious outcome.

You may also hear the terms “active trachoma” (TF and TI) and “cicatricial trachoma” (TS, TT, CO). “Cicatricial” means scar-related disease. Active stages are more common in children. Scar-related stages are more common in adults who had many infections in childhood.

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Causes and Risk Factors

Trachoma has one direct cause: repeated infection by Chlamydia trachomatis (A, B, Ba, C serovars). Many other things make infection more likely. These are called risk factors. They help the germ spread or make the eye easier to infect. I will list 20 important causes and risk factors. Each item has a simple explanation.

1. Direct contact with infected eye discharge.
   When eye fluid from an infected person touches your eye, the germ can enter. This can happen by hand-to-eye touch. It can also happen when a caregiver cleans a child’s face and then rubs their own eye.

2. Sharing towels, cloths, or pillows.
   Wet cloth can carry the germ. Shared towels or bedding can spread infection between family members.

3. Eye-seeking flies.
   Some flies like to land on faces and eyes. They drink the fluid. The fly can carry the germ from one face to another.

4. Crowded living spaces.
   When many people live in one room or a small house, close contact is frequent. Germs pass more easily in tight spaces.

5. Limited clean water.
   When water is scarce, people cannot wash faces often. Eye discharge stays on the skin. Germs spread more.

6. Poor sanitation and lack of toilets.
   When human waste is not well managed, flies increase. Flies can spread many germs, including the trachoma germ.

7. Unclean faces in children.
   Children often have runny noses and eye discharge. If the face is not cleaned, fluid dries on the skin. This attracts flies and spreads germs.

8. Repeated infections over time.
   One infection can heal. But many repeated infections cause scars. Scars lead to turned-in lashes and eye damage.

9. Close care of infected children.
   Mothers, grandmothers, and caregivers touch children’s faces many times a day. This loving care increases exposure if the child is infected.

10. Poverty.
    Poverty limits access to water, soap, toilets, and health care. Poverty also leads to crowded housing. All these conditions raise risk.

11. Remote living with limited health services.
    Far-away communities may have few clinics. Antibiotics and surgery may be hard to reach. Untreated infections persist.

12. Dusty, windy, or smoky environments.
    Dust and smoke irritate eyes. Irritated eyes are rubbed more. Rubbing moves germs from hands to eyes.

13. Poor general hygiene.
    Not washing hands and faces often allows germs to stay on skin. Germs then move into the eye easily.

14. Shared eye cosmetics or eye tools.
    Eye liners or lash curlers can carry germs. Sharing them spreads infection.

15. Household clustering of cases.
    If one person in a home has active trachoma, other members have higher risk. Daily contact spreads germs in the household.

16. Young age.
    Children get infected more easily. They also have more discharge and more fly contact. They are the main reservoir of infection.

17. Female sex in endemic areas.
    Women are often primary caregivers of young children. This role leads to higher exposure and higher rates over time.

18. Co-existing eye surface problems.
    Dry eye or eyelid inflammation can break the eye surface barrier. The germ can enter more easily.

19. Lack of community health education.
    If people do not know how the germ spreads, they may not change behaviors. Education helps reduce spread.

20. Seasonal peaks of flies and crowding.
    Some places have times with more flies or more indoor crowding. Risk can rise during these times.

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Symptoms

Symptoms are what a person feels or notices. Signs are what a clinician sees. Many people with early trachoma have few symptoms. But repeated disease causes symptoms that are hard to ignore. Here are 15 simple symptom descriptions.

1. Itchy eyes.
   The eyes feel scratchy and itchy. You want to rub them.

2. Red eyes.
   The white part of the eye looks pink or red. Blood vessels look larger.

3. Watery discharge.
   Tears run down the face. The eye is always wet.

4. Sticky or mucous discharge.
   There can be thick, stringy discharge. Lids can stick together after sleep.

5. Sandy or foreign-body feeling.
   It feels like sand in the eye. Blinking does not make it go away.

6. Light sensitivity (photophobia).
   Bright light hurts the eyes. You prefer dim rooms or you squint.

7. Pain or burning.
   The eye can sting or burn. Pain can worsen when the lids rub the eye.

8. Swollen eyelids.
   The lids may look puffy and thick. They can feel heavy.

9. Crusting on eyelids.
   Dried discharge can form crusts at the lash line.

10. Frequent blinking.
    Blinking increases to try to clear the irritation.

11. Blurred vision.
    Vision can be unclear. This can be from discharge, corneal scratches, or corneal clouding.

12. Lash scratching (trichiasis discomfort).
    You may feel lashes touching the front of the eye. This is sharp and painful with each blink.

13. Glare and halos.
    Lights can have halos or starbursts. This happens when the cornea is rough or cloudy.

14. Eye fatigue.
    The eye tires quickly. Reading or outdoor work becomes hard.

15. Reduced vision or vision loss (late).
    If the cornea becomes cloudy, central vision can drop. Severe scarring can lead to permanent vision loss.

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Diagnostic Tests

Doctors use a mix of questions, look-and-feel checks, simple tools, and lab tests. Many tests are done in the clinic. Some tests are used to confirm the germ or to study severe cases. Below are 20 tests grouped as Physical Exam, Manual Tests, Lab and Pathological Tests, Electrodiagnostic Tests, and Imaging Tests. For each test, I describe what it is, why it is done, and what it shows. I keep the language plain. I note when a test is “rarely needed.”

A) Physical Exam

1) Visual acuity test (eye chart).
You read letters or symbols on a chart at a set distance. This tells how sharp your vision is. Trachoma can reduce vision if the cornea is scratched or cloudy. This test gives a baseline and tracks change over time.

2) External eye and face inspection.
The clinician looks at the eyes, eyelids, lashes, and the skin around the eyes. They look for redness, swelling, discharge, and crusts. They also check if the face is clean or has dried secretions. This helps judge current activity and risk of spread.

3) Pupillary light reflex and light sensitivity check.
A small light is shined into the eye. The clinician watches the pupil get smaller. They also note if bright light causes pain. This helps rule out inner eye problems and notes surface irritation.

4) Eyelash and lid-margin check for trichiasis.
The clinician looks closely at the lash line. They check if any lashes point inward and touch the cornea. They count misdirected lashes. This is very important in scar-related stages.

5) Corneal surface inspection with a light source.
A bright penlight or a slit lamp (a special microscope) is used to look at the cornea. The clinician looks for scratches, ulcers, or cloudy spots. These findings show how much damage the lashes or infection have caused.

6) Preauricular lymph node palpation.
The clinician gently feels the small lymph nodes in front of the ear. These nodes can be enlarged in eye infections. This supports the diagnosis when other signs are present.

B) Manual Tests

7) Upper eyelid eversion (turning the lid inside out).
The clinician flips the upper lid to see the inner surface. This is a simple, safe maneuver. They look for the classic bumps (follicles), redness, thickening, and scarring lines. This test is key to identifying TF, TI, and TS.

8) Fluorescein staining of the cornea.
A small paper strip with orange dye touches the tear film. Blue light makes the dye glow. Scratches and open spots on the cornea take up the dye and light up green. This shows how much the lashes have scratched the cornea.

9) Q-tip provocation for entropion or lash touch.
A cotton swab gently pushes on the lid margin. This shows if the lid rolls inward easily. It also shows if lashes touch the cornea during blink. This helps decide if surgery is needed.

10) Schirmer tear test (tear quantity).
A narrow paper strip sits under the lower lid for a few minutes. The strip shows how much tear is made. Dry eye can worsen irritation and rubbing. While not specific for trachoma, it helps understand surface comfort.

C) Lab and Pathological Tests

11) Conjunctival swab for NAAT/PCR (detects the germ’s DNA).
A soft swab gently rubs the inner eyelid. The sample goes to a lab. A test called NAAT/PCR looks for the germ’s genetic code. This is a very sensitive test. It confirms current infection.

12) Rapid antigen test (point-of-care, where available).
Some clinics have quick tests that look for germ proteins. A swab from the inner lid is tested on a small device. Results can come fast. These tests are less sensitive than PCR but can help in the field.

13) Giemsa-stained conjunctival smear (microscope look).
A clinician collects a small scraping from the inner lid. The lab stains the sample and looks for inclusion bodies (signs of chlamydia inside cells). This is older technology. It can support the diagnosis where PCR is not available.

14) Culture in special cells (historical and research use).
The germ grows only in living cells. Specialized labs can culture it in cell lines. This is slow and complex. It is rarely done for routine care today.

15) Gram stain and bacterial culture for other germs.
Sometimes other bacteria cause red, sticky eyes. A swab can be tested for those bacteria. This helps rule out other causes or find co-infection that also needs treatment.

16) Antibiotic susceptibility testing for co-pathogens.
If another bacterium grows in culture, the lab tests which antibiotics kill it. This guides care when mixed infection is suspected. It does not test trachoma germ itself, but it helps manage the whole picture.

D) Electrodiagnostic Tests

17) Visual Evoked Potential (VEP).
Small sensors on the scalp measure brain responses to visual patterns. This test checks the vision pathway from eye to brain. It is rarely needed in trachoma. It can help if vision is poor and the cornea findings do not fully explain the loss. It helps rule out deeper visual pathway problems.

(Note: Electroretinography, or ERG, checks retina function. It is almost never needed in trachoma. VEP is listed here as the one electrodiagnostic test that can sometimes help in complex cases.)

E) Imaging Tests

18) External ocular photography.
High-quality photos document lids, lashes, and cornea. Photos help compare change over time. They are also useful for public health surveys and for planning surgery.

19) Anterior Segment Optical Coherence Tomography (AS-OCT).
This is a painless light scan of the front of the eye. It creates cross-section images of the cornea and the angle between cornea and iris. In trachoma, it can show corneal thickness, scars, and surface irregularity. It is helpful when the cornea looks hazy and details are hard to see.

20) In vivo confocal microscopy (IVCM).
This is a special microscope that can image the cornea at the cellular level. It can show nerve loss, scar tissue, and abnormal cells on the surface. It is mainly used in research or specialty clinics. It gives very detailed images when regular exam is limited by scarring.

Non-pharmacological treatments (therapies & other measures)

These are practical, medicine-free actions that support healing, improve comfort, and—most importantly—reduce spread. For each, you’ll see Description, Purpose, and How it works (Mechanism) explained simply.

1. Face washing with clean water and soap, twice daily
   Description: Gently wash eyelids, lashes, and face; wipe away eye and nose discharge.
   Purpose: Removes infectious secretions that spread trachoma.
   Mechanism: Physically clears bacteria from skin and lashes; discourages flies that are attracted to discharge.

2. Dedicated personal towels/cloths
   Description: Each person uses their own clean face cloth or towel.
   Purpose: Stops sharing germs between family members.
   Mechanism: Breaks person-to-person transfer through contaminated cloth.

3. Hand hygiene
   Description: Wash hands after touching faces, changing cloths, or cleaning children.
   Purpose: Reduces hand-to-eye spread.
   Mechanism: Soap and friction remove bacteria from hands.

4. Lash epilation (temporary)
   Description: Trained worker or clinician plucks lashes touching the eye (when surgery is not immediately available).
   Purpose: Short-term relief from scratching and pain.
   Mechanism: Removes the rubbing lashes; does not fix the turned-in lid.

5. Protective eye hygiene with clean saline/lubricating drops
   Description: Sterile saline or preservative-free tears as advised.
   Purpose: Soothes irritation and helps wash away discharge.
   Mechanism: Dilutes irritants and supports the tear film.

6. Fly control in/around the home
   Description: Cover food, reduce animal waste near houses, use screens where possible.
   Purpose: Cuts fly-borne spread.
   Mechanism: Fewer flies = fewer bacteria carried from one face to another.

7. Improve water access
   Description: Community taps, wells, or storage that makes water close and reliable.
   Purpose: Makes daily face-washing easy and routine.
   Mechanism: Convenience increases frequency of hygiene behaviors. Pan American Health Organization

8. Improve sanitation (latrines/toilets)
   Description: Build and use latrines; keep areas free of human waste.
   Purpose: Reduces fly breeding sites.
   Mechanism: Fewer flies = lower transmission. Pan American Health Organization

9. Household cleaning routines
   Description: Regularly clean bedding, clothing, and common surfaces.
   Purpose: Lowers the load of infectious secretions in the home.
   Mechanism: Washing and sunlight help inactivate bacteria.

10. Health education in schools and mothers’ groups
    Description: Simple lessons on face cleanliness and not sharing cloths.
    Purpose: Builds habits where infection starts—among children.
    Mechanism: Knowledge → behavior change → less spread.

11. Community case-finding and referral
    Description: Trained volunteers look for trichiasis and refer for surgery.
    Purpose: Gets the highest-risk people treated quickly.
    Mechanism: Early surgical care prevents corneal damage.

12. Community-wide antibiotic days (as organized by health services)
    Description: Not a “drug treatment” here for individuals, but a public-health activity.
    Purpose: Lowers community bacteria levels—everyone’s risk falls.
    Mechanism: Mass Drug Administration (MDA) interrupts transmission chains. NCBI

13. Reduce crowding where possible
    Description: Improve ventilation; avoid many people sleeping head-to-head.
    Purpose: Limits close-contact spread.
    Mechanism: Greater spacing decreases contact with discharge.

14. Manage nasal discharge in small children
    Description: Wipe away with clean tissue/cloth, then wash hands.
    Purpose: Eye discharge often mixes with nasal discharge—both can carry bacteria.
    Mechanism: Less “sticky” material to attract flies or spread by touch.

15. Keep animals away from living/sleeping areas
    Description: Separate pens or yards for livestock.
    Purpose: Reduces flies near faces.
    Mechanism: Fewer breeding sites next to the home.

16. Sun-drying of washed cloths outdoors
    Description: Dry in direct sunlight when possible.
    Purpose: UV helps inactivate germs.
    Mechanism: Heat and UV damage bacterial structures.

17. Avoid eye cosmetics or irritants during active inflammation
    Description: Pause kohl/liner and harsh cleansers.
    Purpose: Prevents extra irritation.
    Mechanism: Less rubbing, less swelling.

18. Trim nails short
    Description: Keep caregivers’ nails short and clean.
    Purpose: Reduces harboring of secretions and scratching injuries.
    Mechanism: Nails trap fewer germs.

19. Community waste management
    Description: Dispose of garbage away from homes; cover waste.
    Purpose: Reduces flies.
    Mechanism: Fewer breeding sites → fewer fly-eye contacts. Pan American Health Organization

20. Program data tracking and feedback
    Description: Local teams monitor face-washing rates and surgical uptake.
    Purpose: Keeps momentum and identifies gaps.
    Mechanism: Continuous improvement model supports long-term control.

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Drug treatments

Important: Antibiotics clear Chlamydia trachomatis infection. The most widely used medicines are oral azithromycin (single dose) or topical tetracycline 1% (applied for several weeks). When medication is chosen for individuals, dosing and safety must be set by a clinician, especially for pregnant people, infants, and those with other conditions.

1. Azithromycin (oral, single dose)
   Class: Macrolide antibiotic.
   Common dosing used in trachoma control: 20 mg/kg once (max typically up to 1 g in adults) in mass drug administration; individual treatment regimens may vary by program and patient.
   When to take: Given on a single day under supervision during community campaigns or prescribed individually.
   Purpose: Rapidly lowers C. trachomatis in the eye and community.
   Mechanism: Blocks bacterial protein production.
   Side effects: Stomach upset, nausea, rare allergic reaction; interacts with some medicines—medical review is essential. NCBIPMC

2. Tetracycline 1% ophthalmic ointment
   Class: Tetracycline antibiotic (topical).
   Dose commonly used: A small ribbon into the lower eyelid 2× daily for ~6 weeks (programs may differ).
   When to take: Daily at home for weeks; requires adherence.
   Purpose: Alternative where azithromycin is not available/appropriate.
   Mechanism: Stops bacterial protein synthesis on the eye surface.
   Side effects: Local irritation, blurred vision after application; avoid in certain ages/pregnancy—clinician guidance needed. PMC

3. Erythromycin (oral)
   Class: Macrolide.
   Dose (illustrative): Pediatric weight-based dosing when azithromycin is not suitable (clinician decides exact dose/duration).
   When to take: Daily for multiple days.
   Purpose/Mechanism: Macrolide alternative that blocks protein synthesis.
   Side effects: GI upset; drug interactions—medical supervision required.

4. Doxycycline (oral)
   Class: Tetracycline-family antibiotic.
   Dose (illustrative adult): Often 100 mg twice daily for 7–10 days in inclusion conjunctivitis; trachoma programs prefer azithromycin/tetracycline ointment—use only as directed by an eye professional.
   Purpose: Backup option if first-line drugs unsuitable.
   Mechanism: Inhibits bacterial protein synthesis.
   Side effects: Photosensitivity, GI upset; avoid in pregnancy and certain ages.

5. Azithromycin (pediatric liquid)
   Class: Macrolide.
   Dose: Weight-based (mg/kg) single dose per program guidance.
   Purpose/Mechanism/Side effects: As in #1; liquid helps small children swallow. NCBI

6. Topical erythromycin ointment
   Class: Macrolide (topical).
   Dose: Applied to lower fornix several times daily per prescription.
   Purpose: When tetracycline ointment is unavailable or unsuitable.
   Mechanism: Local protein synthesis inhibition.
   Side effects: Mild irritation.

7. Azithromycin (community MDA packs)
   Class: Macrolide; community-level deployment.
   Dose: Programmed by health services using WHO-aligned dosing tools (height sticks/weight bands).
   Purpose: Suppress infection across the whole area.
   Mechanism: Reduces the pool of infection so fewer reinfections occur. NCBI

8. Pain relief (e.g., acetaminophen/paracetamol) — supportive only
   Class: Analgesic.
   Dose: Per label/clinician.
   Purpose: Eases pain from inflamed eyelids/corneal irritation.
   Mechanism: Central pain modulation.
   Side effects: Dose-dependent liver risk if exceeded—follow instructions.

9. Lubricating eye drops (artificial tears) — supportive
   Class: Ocular lubricant.
   Dose: As needed, preservative-free preferred if frequent.
   Purpose: Comfort, reduces friction.
   Mechanism: Restores tear film, dilutes irritants.
   Side effects: Usually minimal.

10. Topical antibiotic for secondary bacterial conjunctivitis (as indicated by clinician)
    Class: Varies (e.g., chloramphenicol, fluoroquinolone)—not for trachoma itself unless a secondary infection is suspected.
    Dose: Per prescription.
    Purpose: Treats added bacterial infections that can worsen irritation.
    Mechanism: Kills susceptible bacteria.
    Side effects: Drug-specific; clinician oversight needed.

Evidence notes: Oral azithromycin and topical tetracycline are the cornerstone antibiotics; community MDA of azithromycin is widely used in endemic settings, while tetracycline ointment is an alternative where azithromycin cannot be used. Comparative trials and systematic reviews support these approaches, though effect sizes vary by setting and coverage. PMCLSHTM Research Online

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Dietary “molecular” supplements

Important: Supplements do not cure trachoma. They may support general eye surface health and immune function alongside medical and public-health care. Always discuss supplements with a clinician, especially in pregnancy, childhood, or when you take other medicines.

1. Vitamin A — Dosage: follow national RDA or clinician guidance (high-dose only when medically indicated). Function: supports surface tissues and night vision. Mechanism: maintains healthy conjunctival cells and immune responses.

2. Zinc — Dosage: within RDA. Function: immune enzyme cofactor. Mechanism: helps the body’s defenses work properly.

3. Vitamin C — Dosage: RDA. Function: antioxidant support. Mechanism: protects cellular structures from oxidative stress during inflammation.

4. Vitamin D — Dosage: RDA unless deficient. Function: immune modulation. Mechanism: influences innate and adaptive immune pathways.

5. Omega-3 fatty acids (ALA/EPA/DHA) — Dosage: per label; consider dietary sources (fish, flax). Function: supports tear film and reduces surface irritation. Mechanism: anti-inflammatory lipid mediators.

6. B-complex (esp. B2, B6, B12) — Dosage: RDA. Function: epithelial health and energy metabolism. Mechanism: supports cell turnover in ocular surface.

7. Selenium — Dosage: RDA. Function: antioxidant enzymes (glutathione peroxidase). Mechanism: limits oxidative damage.

8. Probiotics (dietary yogurt/cultures) — Dosage: per product. Function: gut-immune crosstalk. Mechanism: may support balanced immune signaling; not a treatment.

9. Lutein/Zeaxanthin (dietary greens) — Dosage: via food preferred. Function: general ocular antioxidant support. Mechanism: filters reactive oxygen species.

10. Adequate protein (dietary) — Dosage: per nutritional guidelines. Function: tissue repair. Mechanism: supplies amino acids for healing surfaces.

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Regenerative / stem cell drugs

There are no approved “immunity-booster,” regenerative, or stem-cell drugs to treat or cure trachoma. Trachoma control relies on the SAFE strategy and standard antibiotics; surgery is used to correct eyelid rotation and stop lashes from scratching the eye. Experimental vaccines are being researched, but none are licensed. Because of this, it would be unsafe and misleading to list “stem cell drugs” or “regenerative drugs” with doses for trachoma. The responsible approach is to use proven care (antibiotics, cleanliness, environmental improvement) and, when needed, corrective eyelid surgery. World Health Organization+1

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Surgeries

Surgery is for trichiasis—when in-turned lashes rub the cornea. Procedures are usually done by trained, certified eye surgeons or specially trained non-physician clinicians.

1. Bilamellar Tarsal Rotation (BLTR)
   Procedure: A cut is made through the eyelid plate; the lid margin is rotated outward and stitched so lashes point away from the eye.
   Why: It is the standard, widely taught operation for trachomatous trichiasis, designed for high-volume community programs. World Health OrganizationPMC

2. Trabut procedure (tarsal rotation variant)
   Procedure: An older rotation method using different incision and suturing lines.
   Why: Alternative where training and tradition favor it; still used in some programs. World Health OrganizationPan American Health Organization

3. Posterior Lamellar Tarsal Rotation (PLTR)
   Procedure: Rotates the posterior part of the tarsus to redirect lashes.
   Why: Another effective rotation approach when BLTR is not chosen, depending on surgeon training. World Health Organization

4. Tarsal wedge resection (selected cases)
   Procedure: Removes a wedge of eyelid tissue to correct severe entropion.
   Why: Used in complex scarring patterns when rotation alone is not sufficient.

5. Epilation (as a procedure or bridge to surgery)
   Procedure: Carefully removing offending lashes with forceps; can include electrolysis/follicle destruction in some settings.
   Why: Temporary or adjunct measure when immediate surgery is not available; reduces corneal scratching but does not correct the eyelid position.

WHO’s trichiasis surgery manuals and training programs emphasize BLTR (and alternatives) as core components of the SAFE strategy’s “S.” World Health Organization+1

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Preventions

1. Follow the SAFE strategy—Surgery, Antibiotics, Facial cleanliness, Environmental improvement.

2. Wash children’s faces daily—remove eye/nose discharge.

3. Use personal towels/cloths—no sharing.

4. Frequent handwashing—especially after wiping a child’s face.

5. Improve water access—make washing easy.

6. Use latrines and manage waste—reduce flies.

7. Protect food and reduce animal waste near homes—fewer flies.

8. Reduce household crowding and improve ventilation.

9. School health programs—teach hygiene habits early.

10. Community antibiotic campaigns as organized by health services—lower the infection pool. World Health OrganizationPan American Health Organization

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When to see a doctor (or eye care worker) urgently

• Eye pain, light sensitivity, or the feeling of lashes scratching the eye

• Red, swollen eyelids with discharge that does not improve

• Blurred vision or a white/gray spot on the cornea

• Any child with repeated “sticky eye” and a dirty-appearing face

• Anyone with lashes turning inward (trichiasis)

• After trichiasis surgery, if pain, swelling, or vision worsens

• If you live in an endemic area and have not participated in community antibiotic days or screening

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What to eat and what to avoid

What to eat (10 helpful habits):

1. Colorful vegetables and leafy greens (vitamin A precursors)

2. Seasonal fruits (vitamin C)

3. Beans, lentils, eggs, fish, or lean meats (protein for healing)

4. Whole grains (steady energy)

5. Healthy fats from fish, nuts, and seeds (omega-3s)

6. Clean, safe water—stay well hydrated

7. Yogurt or fermented foods (gut support)

8. Foods fortified with vitamin A/D where available

9. Citrus, tomatoes, peppers (extra antioxidants)

10. Regular, balanced meals (avoid malnutrition)

What to avoid (10 sensible limits):

1. Street foods exposed to flies or dust

2. Unclean water or ice of unknown source

3. Ultra-processed snacks in place of real meals

4. Very high sugar intake that displaces nutritious foods

5. Excessive alcohol (slows healing)

6. Smoking or smoky cooking areas (eye irritation)

7. Sharing cups/utensils if someone has eye discharge

8. Rubbing eyes with unwashed hands

9. Using other people’s towels/cloths

10. DIY eye remedies (herbal drops, unsterile substances)

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Frequently Asked Questions

1) Is trachoma the same as “pink eye”?
No. “Pink eye” just means a red, irritated eye from many causes. Trachoma is a specific bacterial infection that, when repeated, scars the eyelids and can cause blindness if not controlled.

2) Can trachoma be cured?
Yes—the infection can be cleared with antibiotics, and surgery can correct inward-turning lashes. Long-term elimination in communities comes from the SAFE strategy. World Health Organization

3) Who gets trachoma most often?
Children get the initial infections most; women caring for children are also at higher risk due to close contact. Over time, repeated infections cause trouble in adults.

4) How does it spread?
By hands, shared cloths/towels, and eye-seeking flies that land on faces with discharge.

5) Do I always feel pain with trachoma?
Early infections may be mild. Pain and light sensitivity often appear later, especially when lashes start scraping the eye.

6) What is “trichiasis”?
It means lashes are turned inward and rub the cornea. It needs surgery or, if unavailable immediately, temporary epilation. World Health Organization

7) What antibiotic is most used?
Azithromycin—often as a single oral dose in community programs—or tetracycline 1% ointment for several weeks. Your clinician will choose based on age, pregnancy status, and local guidelines. NCBIPMC

8) If I take antibiotics once, am I protected forever?
No. You can be reinfected if hygiene and environmental conditions still allow spread. That’s why facial cleanliness and environmental improvements matter.

9) Can eye drops alone fix trachoma?
Lubricating drops can soothe, but they do not kill the trachoma bacteria. Antibiotics are required to clear infection.

10) Is there a vaccine for trachoma?
Not yet. Research is ongoing, but there is no licensed vaccine at this time.

11) Why does WHO emphasize water, sanitation, and hygiene (WASH)?
Because these changes cut transmission at its source—clean faces and fewer flies mean fewer new infections. Pan American Health Organization

12) What happens if trichiasis is not treated?
Constant lash scraping scars the cornea and can lead to permanent vision loss.

13) Are children treated differently?
Children receive weight-based dosing and liquid formulations as needed. Programs use careful dosing tools to keep it safe and effective. NCBI

14) Can I use home remedies?
No. Avoid putting unsterile liquids or plant juices in the eye. They can worsen inflammation or cause infection.

15) How do communities get rid of trachoma?
By combining Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement—done consistently for enough time to interrupt transmission. World Health Organization

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 28, 2025.