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Trachoma

Last reviewed: 1 Apr 2025
Last updated: 02 Jan 2024

Summary

Definition

History and exam

Key diagnostic factors

  • residence in or emigration from an endemic area
  • at-risk demographic
  • subtarsal conjunctival inflammation
  • subtarsal follicles
  • subtarsal conjunctival scarring
  • trichiasis
  • corneal opacification and visual loss
  • Herbert pits
Full details

Other diagnostic factors

  • asymptomatic
  • ocular and nasal discharge
  • red eye
  • painful watery eye
  • limbal follicles
  • pannus
Full details

Risk factors

  • children (ages 1 to 9 years)
  • poor facial hygiene
  • female sex
  • poverty
  • poor community hygiene
  • crowded households
  • residence in or emigration from an endemic area
  • eye-seeking flies
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • polymerase chain reaction (conjunctival swab)
Full details

Emerging tests

  • novel molecular and serologic tests

Treatment algorithm

ACUTE

resource-poor endemic area: based on prevalence of active trachoma

resource-rich nonendemic area: infected individual and family contact

ONGOING

resource-poor endemic area: trachomatous trichiasis

resource-rich nonendemic area: trachomatous trichiasis

Contributors

Authors

Van Charles Lansingh, MD, PhD, MBA

Associate Professor of Ophthalmology

Moran Eye Center

University of Utah

UT

Voluntary Associate Professor

Public Health Sciences

Miller School of Medicine

University of Miami

FL

Help Me See Chief Medical Officer

Director of Research

IMO (Mexican Institute of Ophthalmology)

Santiago de Queretaro

Mexico

Disclosures

VCL declares that he has no competing interests.

Kelly Callahan, MPH

Director

Trachoma Control Program

The Carter Center

Atlanta

GA

Disclosures

KC declares that she has no competing interests.

Acknowledgements

Dr Van Charles Lansingh and Ms Kelly Callahan wish to gratefully acknowledge Dr Paul Emerson, Dr Heathcote R. Wright and Dr Hugh R. Taylor, previous contributors to this topic.

Disclosures

PE declares no competing interests. HRW and HRT are authors of a number of references cited in the topic.

Peer reviewers

Matthew Burton, BChir

Lecturer

International Centre for Eye Health

London School of Hygiene and Tropical Medicine

London

UK

Disclosures

MB declares that he has no competing interests.

Victor Perez, MD

Assistant Professor

Miller School of Medicine

Bascom Palmer Eye Institute

University of Miami

Miami

FL

Disclosures

VP declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. Trachoma control: a guide for programme managers. Jul 2006 [internet publication].Full text

World Health Organization. Report of the 4th global scientific meeting on trachoma, Geneva, 27-29 November 2018. Jun 2019. [internet publication].Full text

Evans JR, Solomon AW, Kumar R, et al. Antibiotics for trachoma. Cochrane Database Syst Rev. 2019 Sep 26;9:CD001860.Full text  Abstract

Ejere HO, Alhassan MB, Rabiu M. Face washing promotion for preventing active trachoma. Cochrane Database Syst Rev. 2015 Feb 20;(2):CD003659.Full text  Abstract

Burton M, Habtamu E, Ho D, et al. Interventions for trachoma trichiasis. Cochrane Database Syst Rev. 2015 Nov 13;(11):CD004008.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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