The World’s Leading Cause of Preventable Blindness
Trachoma is an infectious eye disease caused by the bacterium Chlamydia trachomatis, which spreads by contact with an infected person’s hands or clothing. It is the world's leading cause of preventable blindness, and is one of the oldest diseases known to man.
Trachoma was once endemic in Europe and the United States. European immigrants to America had their eyelids flipped and examined upon arrival at Ellis Island in New York. Nine of 10 immigrants diagnosed with active trachoma were returned to their home countries. Trachoma disappeared in Europe, even before antibiotics, because of improved living standards.
Today, about 41 million people, mostly women and children, have active trachoma and need treatment. An estimated 8.2 million people have an advanced stage of the disease in which the eyelashes turn inward and scrape the cornea, a condition called trichiasis. These people face the risk of visual impairment or blindness unless treated with a simple surgical procedure.
Infections start in early childhood but people infected with trachoma do not instantly go blind. Trachoma manifests gradually, with repeated infections over childhood leading to scar formation of the conjunctiva of the upper eyelid.This causes the eyelashes to turn inward and scratch the cornea. This may lead slowly and painfully to complete blindness.
The poorest of the poor suffer most from trachoma, especially in areas that have limited access to water and sanitation. Africa is the most affected continent. Trachoma is believed to be endemic in 57 countries. Globally, 1.2 billion people live in trachoma-endemic areas, primarily in the poorest communities in the developing world.
Trachoma Destroys Families
Trachoma can destroy the economic well-being of entire communities, keeping families shackled within a cycle of poverty as the disease and its long-term effects pass from one generation to the next.
Globally, trachoma results in an estimated US $2.9 billion in lost productivity per year. Blindness from trachoma strikes adults in their prime years, hindering their ability to care for themselves and their families.
Women, traditionally the caretakers of the home, are twice as likely as men to have trichiasis. When a woman can no longer perform vital activities for her household, an older daughter is often removed from school to assume her mother’s duties, thus losing her opportunity for a formal education.
A Hidden Disease
Though trachoma is widespread, it is little-known outside of affected communities which are isolated and rural. In some communities, the disease is so common that blindness from trachoma is simply accepted as a fact of life.
Trachoma spreads easily, from child to child, and child to caregiver. The disease begins in childhood, and initially the infection clears up on its own. But repeated infections cause inflammation and scarring of the conjunctiva. Scarring causes the upper eyelid to turn inward, which causes the eyelashes to rub on the cornea. This leads to corneal abrasions, corneal scarring, opacification and ultimately blindness, usually in adulthood.
A Preventable Disease
Trachoma is treatable and preventable with a multifaceted approach known as the SAFE strategy.
Recommended by the World Health Organization, the SAFE strategy is a comprehensive public health approach that combines treatment (Surgery and Antibiotics) with prevention (Facial-cleanliness and Environmental improvement).
Antibiotic treatment will provide a short-term cure, especially when the whole community is treated, but reinfection can occur unless treatment is accompanied by behavioral changes. It is essential that the full SAFE strategy be in place in trachoma-endemic communities.
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