Trachoma

Trachoma is an infectious disease caused by bacterium Chlamydia trachomatis.[2] The infection

causes a roughening of the inner surface of the eyelids.[2] This roughening can lead to pain in the
eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness.[2] Untreated,
repeated trachoma infections can result in a form of permanent blindness when the eyelids turn
inward.[2]
 Trachoma

Other names Granular conjunctivitis, blinding trachoma,

Egyptian ophthalmia[1]

Surgical repair of in-turned eyelid and eyelashes resulting from trachoma

Specialty Infectious disease

Symptoms Eye pain, blindness[2]

Causes Chlamydia trachomatis spread between people[2]

Risk factors Crowded living conditions, not enough clean water

and toilets[2]

Prevention Mass treatment, improved sanitation[3]

Treatment Medications, surgery[2]

Medication Azithromycin, tetracycline[3]

Frequency 80 million[4]

The bacteria that cause the disease can be spread by both direct and indirect contact with an
affected person's eyes or nose.[2] Indirect contact includes through clothing or flies that have
come into contact with an affected person's eyes or nose.[2] Children spread the disease more
often than adults.[2] Poor sanitation, crowded living conditions, and not enough clean water and
toilets also increase spread.[2]

Efforts to prevent the disease include improving access to clean water and treatment with
antibiotics to decrease the number of people infected with the bacterium.[2] This may include
treating, all at once, whole groups of people in whom the disease is known to be common.[3]
Washing, by itself, is not enough to prevent disease, but may be useful with other measures.[5]
Treatment options include oral azithromycin and topical tetracycline.[3] Azithromycin is preferred
because it can be used as a single oral dose.[6] After scarring of the eyelid has occurred, surgery
may be required to correct the position of the eyelashes and prevent blindness.[2]

Globally, about 80 million people have an active infection.[4] In some areas, infections may be
present in as many as 60–90% of children.[2] Among adults, it more commonly affects women
than men – likely due to their closer contact with children.[2] The disease is the cause of
decreased vision in 2.2 million people, of whom 1.2 million are completely blind.[2] Trachoma is a
public health problem in 44 countries across Africa, Asia, and Central and South America, with
136.9 million people at risk.[2] It results in US$8 billion of economic losses a year.[2] It belongs to
a group of diseases known as neglected tropical diseases.[4]

Signs and symptoms

The bacterium has an incubation period of 6 to 12 days, after which the affected individual
experiences symptoms of conjunctivitis, or irritation similar to "pink eye". Blinding endemic
trachoma results from multiple episodes of reinfection that maintains the intense inflammation
in the conjunctiva. Without reinfection, the inflammation gradually subsides.[7]

The conjunctival inflammation is called "active trachoma" and usually is seen in children,
especially preschool children. It is characterized by white lumps in the undersurface of the upper
eyelid (conjunctival follicles or lymphoid germinal centres) and by nonspecific inflammation and
thickening often associated with papillae. Follicles may also appear at the junction of the cornea
and the sclera (limbal follicles). Active trachoma often can be irritating and have a watery
discharge. Bacterial secondary infection may occur and cause a purulent discharge.

The later structural changes of trachoma are referred to as "cicatricial trachoma". These include
scarring in the eyelid (tarsal conjunctiva) that leads to distortion of the eyelid with buckling of
the lid (tarsus) so the lashes rub on the eye (trichiasis). These lashes can lead to corneal
opacities and scarring and then to blindness. Linear scar present in the sulcus subtarsalis is
called Arlt's line (named after Carl Ferdinand von Arlt). In addition, blood vessels and scar tissue
can invade the upper cornea (pannus). Resolved limbal follicles may leave small gaps in the
pannus (Herbert's pits).[8]

Most commonly, children with active trachoma do not present with any symptoms, as the low-
grade irritation and ocular discharge is just accepted as normal, but further symptoms may
include:

Eye discharge

Swollen eyelids

Trichiasis (misdirected eyelashes)

Swelling of lymph nodes in front of the ears

Sensitivity to bright lights

Increased heart rate

Further ear, nose, and throat complications.

The major complication or the most important one is corneal ulcer occurring due to rubbing by
concentrations, or trichiasis with superimposed bacterial infection.

Cause

Trachoma is caused by Chlamydia trachomatis, serotypes (serovars) A, B, and C.[9] It is spread by

direct contact with eye, nose, and throat secretions from affected individuals, or contact with
fomites[10] (inanimate objects that carry infectious agents), such as towels and/or washcloths,
that have had similar contact with these secretions. Flies can also be a route of mechanical
transmission.[10] Untreated, repeated trachoma infections result in entropion (the inward turning
of the eyelids), which may result in blindness due to damage to the cornea. Children are the
most susceptible to infection due to their tendency to get dirty easily, but the blinding effects or
more severe symptoms are often not felt until adulthood.

Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors
are indirectly linked to the presence of trachoma including lack of water, absence of latrines or
toilets, poverty in general, flies, close proximity to cattle, and crowding.[7][11] The final common
pathway, though, seems to be the presence of dirty faces in children, facilitating the frequent
exchange of infected ocular discharge from one child's face to another. Most transmission of
trachoma occurs within the family.[7]

Diagnosis

McCallan's classification

McCallan in 1908 divided the clinical course of trachoma into four stages:

Stage 1 (incipient Stage 2 (established Stage 3 (cicatrising Stage 4 (healed

trachoma) trachoma) trachoma) trachoma)

Hyperaemia of
Appearance of mature Scarring of palpebral Disease is cured or is
palpebral
follicle & papillae conjunctiva not markable
conjunctiva

Progressive corneal Scars are easily Sequelae to cicatrisation

Immature follicle
pannus visible as white bands cause symptoms

WHO classification

The World Health Organization recommends a simplified grading system for trachoma.[12] The
Simplified WHO Grading System is summarized below:

Trachomatous inflammation, follicular (TF)—Five or more follicles of >0.5 mm on the upper

tarsal conjunctiva

Trachomatous inflammation, intense (TI)—Papillary hypertrophy and inflammatory thickening of

the upper tarsal conjunctiva obscuring more than half the deep tarsal vessels

Trachomatous scarring (TS)—Presence of scarring in tarsal conjunctiva.

Trachomatous trichiasis (TT)—At least one ingrown eyelash touching the globe, or evidence of
epilation (eyelash removal)

Corneal opacity (CO)—Corneal opacity blurring part of the pupil margin

Prevention
Although trachoma was eliminated from much of the developed world in the 20th century
(Australia being a notable exception), this disease persists in many parts of the developing
world, particularly in communities without adequate access to water and sanitation.[13]

Environmental measures

Environmental improvement: Modifications in water use, fly control, latrine use, health education,
and proximity to domesticated animals have all been proposed to reduce transmission of C.
trachomatis. These changes pose numerous challenges for implementation. These
environmental changes are likely to ultimately affect the transmission of ocular infection by
means of lack of facial cleanliness.[7] Particular attention is required for environmental factors
that limit clean faces.

A systematic review examining the effectiveness of environmental sanitary measures on the

prevalence of active trachoma in endemic areas showed that use of insecticide spray resulted in
significant reductions of trachoma and fly density in some studies.[14] Health education also
resulted in reductions of active trachoma when implemented.[14] Improved water supply did not
result in a reduction of trachoma incidence.[14]

Antibiotics

WHO Guidelines recommend that a region should receive community-based, mass antibiotic
treatment when the prevalence of active trachoma among one- to nine-year-old children is
greater than 10%.[15] Subsequent annual treatment should be administered for three years, at
which time the prevalence should be reassessed. Annual treatment should continue until the
prevalence drops below 5%. At lower prevalences, antibiotic treatment should be family-based.

Management

Antibiotics

Azithromycin (single oral dose of 20 mg/kg) or topical tetracycline (1% eye ointment twice a day
for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is
expensive, it is generally used as part of the international donation program organized by
Pfizer.[6] Azithromycin can be used in children from the age of six months and in pregnancy.[7] As
a community-based antibiotic treatment, some evidence suggests that oral azithromycin was
more effective than topical tetracycline, but no consistent evidence supported either oral or
topical antibiotics as being more effective.[3] Antibiotic treatment reduces the risk of active
trachoma in individuals infected with chlamydial trachomatis.[3]

Surgery

For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the
lashes away from the globe.[16] Evidence suggests that use of a lid clamp and absorbable
sutures would result in reduced lid contour abnormalities and granuloma formulation after
surgery.[17] Early intervention is beneficial as the rate of recurrence is higher in more advanced
disease.[18]

Lifestyle measures

The WHO-recommended SAFE strategy includes:

Surgery to correct advanced stages of the disease

Antibiotics to treat active infection, using azithromycin

Facial cleanliness to reduce disease transmission

Environmental change to increase access to clean water and improved sanitation

Children with visible nasal discharge, discharge from the eyes, or flies on their faces are at least
twice as likely to have active trachoma as children with clean faces.[7] Intensive community-
based health education programs to promote face-washing can reduce the rates of active
trachoma, especially intense trachoma. If an individual is already infected, washing one's face is
encouraged, especially a child, to prevent reinfection.[19] Some evidence shows that washing the
face combined with topical tetracycline might be more effective in reducing severe trachoma
compared to topical tetracycline alone.[5] The same trial found no statistical benefit of eye
washing alone or in combination with tetracycline eye drops in reducing follicular trachoma
amongst children.[5]

Prognosis

If not treated properly with oral antibiotics, the symptoms may escalate and cause blindness,
which is the result of ulceration and consequent scarring of the cornea. Surgery may also be
necessary to fix eyelid deformities.
Without intervention, trachoma keeps families in a cycle of poverty, as the disease and its long-
term effects are passed from one generation to the next.

Epidemiology

Disability-adjusted life year for trachoma per 100,000 inhabitants in 2004

no data
≤10
10–20
20–40
40–60
60–80
80–100
100–200
200–300
300–400
400–500
500–600
≥600

As of 2011, about 21 million people are actively affected by trachoma, with around 2.2 million
people being permanently blind or have severe visual impairment from trachoma. An additional
7.3 million people are reported to have trichiasis.[20] 51 countries are currently classified as
endemic for blinding trachoma.[21] Of these, Africa is considered the worst affected area, with
over 85% of all known active cases of trachoma.[21] Within the continent, South Sudan and
Ethiopia have the highest prevalence.[21] In many of these communities, women are three times
more likely than men to be blinded by the disease, due to their roles as caregivers in the family.
Approximately 158 million people are living in areas were trachoma is common.[22] An additional
229 million live where trachoma could potentially occur.[21] Australia is the only developed
country that has trachoma.[23] In 2008, trachoma was found in half of Australia's very remote
communities.[23]

Elimination

In 1996, the WHO launched its Alliance for the Global Elimination of Trachoma by 2020,[24] and in
2006, the WHO officially set 2020 as the target to eliminate trachoma as a public-health
problem.[25] The International Coalition for Trachoma Control has produced maps and a
strategic plan called 2020 INSight that lays out actions and milestones to achieve global
elimination of blinding trachoma by 2020.[26] The program recommends the SAFE protocol for
blindness prevention: Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and
Environmental improvement to reduce transmission.[24] This includes sanitation infrastructure to
reduce the open presence of human feces that can breed flies.[27]

As of 2018, Cambodia, Ghana, Iran, Laos, Mexico, Nepal, Morocco, and Oman have been certified
as having eliminated trachoma as a public-health problem; China, Gambia, Iran, Iraq, and
Myanmar make that claim, but have not sought certification.[27] Eradication of the bacterium that
causes the disease is seen as impractical; the WHO definition of "eliminated as a public-health
problem" means less than 5% of children have any symptoms, and less than 0.1% of adults have
vision loss.[27] Having already donated more doses (about 700 million since 2002) of the drug
than it has sold during the same time period, the drug company Pfizer has agreed to donate
azithromycin until 2025, if necessary, for elimination of the disease.[27] The campaign
unexpectedly found distribution of azithromycin to very poor children reduced their early death
rate by up to 25%.[27]

History

The disease is one of the earliest known eye afflictions, having been identified in Egypt as early
as 15 BC.[7]

Its presence was also recorded in ancient China and Mesopotamia. Trachoma became a
problem as people moved into crowded settlements or towns where hygiene was poor. It
became a particular problem in Europe in the 19th century. After the Egyptian Campaign (1798–
1802) and the Napoleonic Wars (1798–1815), trachoma was rampant in the army barracks of
Europe and spread to those living in towns as troops returned home. Stringent control measures
were introduced, and by the early 20th century, trachoma was essentially controlled in Europe,
although cases were reported until the 1950s.[7] Today, most victims of trachoma live in
underdeveloped and poverty-stricken countries in Africa, the Middle East, and Asia.

In the United States, the Centers for Disease Control says, "No national or international
surveillance [for trachoma] exists. Blindness due to trachoma has been eliminated from the
United States. The last cases were found among Native American populations and in
Appalachia, and those in the boxing, wrestling, and sawmill industries (prolonged exposure to
combinations of sweat and sawdust often led to the disease). In the late 19th and early 20th
centuries, trachoma was the main reason for an immigrant coming through Ellis Island to be
deported."[28][29]

In 1913, President Woodrow Wilson signed an act designating funds for the eradication of the
disease.[30][31] Immigrants who attempted to enter the U.S. through Ellis Island, New York, had to
be checked for trachoma.[28] During this time, treatment for the disease was by topical
application of copper sulfate. By the late 1930s, a number of ophthalmologists reported success
in treating trachoma with sulfonamide antibiotics.[32] In 1948, Vincent Tabone (who was later to
become the President of Malta) was entrusted with the supervision of a campaign in Malta to
treat trachoma using sulfonamide tablets and drops.[33]

Due to improved sanitation and overall living conditions, trachoma virtually disappeared from the
industrialized world by the 1950s, though it continues to plague the developing world to this day.
Epidemiological studies were conducted in 1956–63 by the Trachoma Control Pilot Project in
India under the Indian Council for Medical Research.[34] This potentially blinding disease remains
endemic in the poorest regions of Africa, Asia, and the Middle East and in some parts of Latin
America and Australia. Currently, 8 million people are visually impaired as a result of trachoma,
and 41 million suffer from active infection.

Of the 54 countries that the WHO cited as still having blinding trachoma occurring, Australia is
the only developed country—Australian Aboriginal people who live in remote communities with
inadequate sanitation are still blinded by this infectious eye disease.[35]

India's Health and Family Welfare Minister JP Nadda declared India free of infective trachoma in
2017.[36]

Etymology

The term is derived from New Latin trāchōma, from Greek τράχωμα trākhōma, from τραχύς
trākhus "rough".[37]
 Economics

The economic burden of trachoma is huge, particularly with regard to covering treatment costs
and productivity losses as a result of increased visual impairment, and in some cases,
permanent blindness.[2] The global estimated cost of trachoma is reported between $US2.9 and
5.3 billion each year.[2] By including the cost for trichiasis treatment, the estimated overall cost
for the disease increases to about $US 8 billion.[2]

References

1. Swanner, Yann A. Meunier; with contributions from Michael Hole, Takudzwa Shumba & B.J. (2014).
Tropical diseases : a practical guide for medical practitioners and students (https://books.google.com/b
ooks?id=ZWcGAQAAQBAJ&pg=PT222) . Oxford: Oxford University Press, USA. p. 199.
ISBN 9780199997909. Archived (https://web.archive.org/web/20170908222538/https://books.google.co
m/books?id=ZWcGAQAAQBAJ&pg=PT222) from the original on 8 September 2017.

2. "Blinding Trachoma Fact sheet N°382" (https://www.who.int/mediacentre/factsheets/fs382/en/) .

World Health Organization. November 2013. Archived (https://web.archive.org/web/20140314061724/htt
p://www.who.int/mediacentre/factsheets/fs382/en/) from the original on 14 March 2014. Retrieved
14 March 2014.

3. Evans, Jennifer R.; Solomon, Anthony W.; Kumar, Rahul; Perez, Ángela; Singh, Balendra P.; Srivastava,
Rajat Mohan; Harding-Esch, Emma (26 September 2019). "Antibiotics for trachoma" (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC6760986) . The Cochrane Database of Systematic Reviews. 9: CD001860.
doi:10.1002/14651858.CD001860.pub4 (https://doi.org/10.1002%2F14651858.CD001860.pub4) .
ISSN 1469-493X (https://www.worldcat.org/issn/1469-493X) . PMC 6760986 (https://www.ncbi.nlm.ni
h.gov/pmc/articles/PMC6760986) . PMID 31554017 (https://pubmed.ncbi.nlm.nih.gov/31554017) .

4. Fenwick, A (March 2012). "The global burden of neglected tropical diseases". Public Health. 126 (3):
233–6. doi:10.1016/j.puhe.2011.11.015 (https://doi.org/10.1016%2Fj.puhe.2011.11.015) .
PMID 22325616 (https://pubmed.ncbi.nlm.nih.gov/22325616) .

5. Ejere, HO; Alhassan, MB; Rabiu, M (20 February 2015). "Face washing promotion for preventing active
trachoma" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441394) . Cochrane Database of
Systematic Reviews. 2 (2): CD003659. doi:10.1002/14651858.CD003659.pub4 (https://doi.org/10.1002%
2F14651858.CD003659.pub4) . PMC 4441394 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441
394) . PMID 25697765 (https://pubmed.ncbi.nlm.nih.gov/25697765) .

6. Mariotti SP (November 2004). "New steps toward eliminating blinding trachoma". New England Journal
of Medicine. 351 (19): 2004–7. doi:10.1056/NEJMe048205 (https://doi.org/10.1056%2FNEJMe04820
5) . PMID 15525727 (https://pubmed.ncbi.nlm.nih.gov/15525727) .
 7. Taylor, Hugh (2008). Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-first Century.
Centre for Eye Research Australia. ISBN 978-0-9757695-9-1.

8. Feibel, Robert M. (1 May 2014). "Herbert Herbert: His Corneal Pits and Scleral Slits" (https://www.aaojour
nal.org/article/S0161-6420(13)01080-4/abstract) . Ophthalmology. 121 (5): 1142–1148.
doi:10.1016/j.ophtha.2013.11.018 (https://doi.org/10.1016%2Fj.ophtha.2013.11.018) . ISSN 0161-6420
(https://www.worldcat.org/issn/0161-6420) . PMID 24424250 (https://pubmed.ncbi.nlm.nih.gov/2442
4250) .

9. Mackern-Oberti, J. P.; Motrich, R. N. D. O.; Breser, M. A. L.; Sánchez, L. R.; Cuffini, C.; Rivero, V. E. (2013).
"Chlamydia trachomatis infection of the male genital tract: An update". Journal of Reproductive
Immunology. 100 (1): 37–53. doi:10.1016/j.jri.2013.05.002 (https://doi.org/10.1016%2Fj.jri.2013.05.00
2) . PMID 23870458 (https://pubmed.ncbi.nlm.nih.gov/23870458) .

10. Goldman, Lee (2011). Goldman's Cecil Medicine (24th ed.). Philadelphia: Elsevier Saunders. pp. e326-2.
ISBN 978-1437727883.

11. Wright HR, Turner A, Taylor HR (June 2008). "Trachoma". Lancet. 371 (9628): 1945–54.
doi:10.1016/S0140-6736(08)60836-3 (https://doi.org/10.1016%2FS0140-6736%2808%2960836-3) .
PMID 18539226 (https://pubmed.ncbi.nlm.nih.gov/18539226) . S2CID 208790087 (https://api.semantic
scholar.org/CorpusID:208790087) .

12. Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR (1987). "A simple system for the assessment of
trachoma and its complications" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491032) . Bulletin
of the World Health Organization. 65 (4): 477–83. PMC 2491032 (https://www.ncbi.nlm.nih.gov/pmc/arti
cles/PMC2491032) . PMID 3500800 (https://pubmed.ncbi.nlm.nih.gov/3500800) .

13. Stocks, Meredith E. (2014). "Effect of Water, Sanitation, and Hygiene on the Prevention of Trachoma: A
Systematic Review and Meta-Analysis" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934994) .
PLOS Medicine. 11 (2): e1001605. doi:10.1371/journal.pmed.1001605 (https://doi.org/10.1371%2Fjourn
al.pmed.1001605) . PMC 3934994 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934994) .
PMID 24586120 (https://pubmed.ncbi.nlm.nih.gov/24586120) .

14. Rabiu M, Alhassan MB, Ejere HO, Evans JR (2012). "Environmental sanitary interventions for preventing
active trachoma" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422499) . Cochrane Database of
Systematic Reviews. 2 (2): CD004003. doi:10.1002/14651858.CD004003.PUB4 (https://doi.org/10.100
2%2F14651858.CD004003.PUB4) . PMC 4422499 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC442
2499) . PMID 22336798 (https://pubmed.ncbi.nlm.nih.gov/22336798) .

15. Solomon, AW; Zondervan M; Kuper H; et al. (2006). "Trachoma control: a guide for programme managers"
(https://www.who.int/blindness/publications/tcm%20who_pbd_get_06_1.pdf) (PDF). World Health
Organization. Archived (https://web.archive.org/web/20080712163224/http://www.who.int/blindness/pu
blications/tcm%20who_pbd_get_06_1.pdf) (PDF) from the original on 12 July 2008.

16. Reacher M, Foster A, Huber J. "Trichiasis Surgery for Trachoma. The Bilamellar Tarsal Rotation
Procedure." 1993; World Health Organization, Geneva: WHO/PBL/93.29.
17. Burton M, Habtamu E, Ho D, Gower EW (2015). "Interventions for trachoma trichiasis" (https://www.ncbi.n
lm.nih.gov/pmc/articles/PMC4661324) . Cochrane Database of Systematic Reviews. 11 (11):
CD004008. doi:10.1002/14651858.CD004008.pub3 (https://doi.org/10.1002%2F14651858.CD004008.
pub3) . PMC 4661324 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661324) . PMID 26568232 (h
ttps://pubmed.ncbi.nlm.nih.gov/26568232) .

18. Burton MJ, Kinteh F, Jallow O, et al. (October 2005). "A randomised controlled trial of azithromycin
following surgery for trachomatous trichiasis in the Gambia" (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC1772881) . British Journal of Ophthalmology. 89 (10): 1282–8. doi:10.1136/bjo.2004.062489 (htt
ps://doi.org/10.1136%2Fbjo.2004.062489) . PMC 1772881 (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC1772881) . PMID 16170117 (https://pubmed.ncbi.nlm.nih.gov/16170117) .

19. Prevention-Trachoma (http://mayoclinic.com/health/trachoma/DS00776/DSECTION=prevention)

Archived (https://web.archive.org/web/20090515083540/http://www.mayoclinic.com/health/trachoma/
DS00776/DSECTION%3Dprevention) 2009-05-15 at the Wayback Machine 18 July 2008 – 24 March
2009

20. Taylor, Hugh R; Burton, Matthew J; Haddad, Danny; West, Sheila; Wright, Heathcote (December 2014).
"Trachoma". The Lancet. 384 (9960): 2142–2152. doi:10.1016/s0140-6736(13)62182-0 (https://doi.org/1
0.1016%2Fs0140-6736%2813%2962182-0) . ISSN 0140-6736 (https://www.worldcat.org/issn/0140-6
736) . PMID 25043452 (https://pubmed.ncbi.nlm.nih.gov/25043452) . S2CID 208793607 (https://api.s
emanticscholar.org/CorpusID:208793607) .

21. "Epidemiological situation" (https://www.who.int/trachoma/epidemiology/en/) . World Health

Organization. Retrieved 1 November 2018.

22. "Trachoma" (https://www.who.int/en/news-room/fact-sheets/detail/trachoma) . World Health

Organization. Retrieved 2 November 2018.

23. "Eye health in Aboriginal and Torres Strait Islander people" (https://web.archive.org/web/2012102807581
1/http://www.aihw.gov.au/indigenous-observatory-eye-health/) . Australian Institute of Health and
Welfare. 2008. Archived from the original (http://www.aihw.gov.au/indigenous-observatory-eye-health/)
on 28 October 2012. Retrieved 11 April 2013.

24. "Ghana eliminates trachoma, freeing millions from suffering and blindness" (http://www.afro.who.int/new
s/ghana-eliminates-trachoma-freeing-millions-suffering-and-blindness) . World Health Organization. 13
June 2018. Retrieved 13 June 2018.

25. "WHO | Blinding trachoma: Progress towards global elimination by 2020" (https://www.who.int/mediacen
tre/news/notes/2006/np09/en/) . 10 April 2006. Archived (https://web.archive.org/web/201507080448
24/http://www.who.int/mediacentre/news/notes/2006/np09/en/) from the original on 8 July 2015.
Retrieved 5 August 2015.
26. "Global strategy lays out concrete action plan to eliminate blinding trachoma by 2020" (https://web.archiv
e.org/web/20141108172604/http://www.trachomacoalition.org/node/713) . International Coalition for
Trachoma Control. July 2011. Archived from the original (http://www.trachomacoalition.org/node/713)
on 8 November 2014. Retrieved 8 November 2014.

27. McNeil, Donald G. Jr. (16 July 2018). "Now in Sight: Success Against an Infection That Blinds" (https://w
ww.nytimes.com/2018/07/16/health/trachoma-blindness-nepal.html) . The New York Times. Retrieved
3 September 2018.

28. Yew, E (June 1980). "Medical inspection of immigrants at Ellis Island, 1891–1924" (https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC1805119) . Bulletin of the New York Academy of Medicine. 56 (5): 488–510.
PMC 1805119 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805119) . PMID 6991041 (https://pub
med.ncbi.nlm.nih.gov/6991041) .

29. Disease Listing, Trachoma, Technical Information | CDC Bacterial, Mycotic Diseases (https://www.cdc.go
v/ncidod/dbmd/diseaseinfo/trachoma_t.htm) Archived (https://web.archive.org/web/2006041813522
1/http://www.cdc.gov/ncidod/dbmd/diseaseinfo/trachoma_t.htm) 2006-04-18 at the Wayback
Machine.

30. Allen SK, Semba RD (2002). "The trachoma menace in the United States, 1897–1960". Survey of
Ophthalmology. 47 (5): 500–9. doi:10.1016/S0039-6257(02)00340-5 (https://doi.org/10.1016%2FS0039-
6257%2802%2900340-5) . PMID 12431697 (https://pubmed.ncbi.nlm.nih.gov/12431697) .

31. Leupp, Constance D. (August 1914). "Removing The Blinding Curse Of The Mountains: How Dr. McMullen,
Of The Public Health Service Is Organizing The War Against Trachoma In The Appalachians" (https://boo
ks.google.com/books?id=zegeQtMn9JsC&pg=PA426) . The World's Work: A History of Our Time. XLIV
(2): 426–430. Retrieved 4 August 2009.

32. Thygeson P (1939). "The Treatment of Trachoma with Sulfanilamide: A Report of 28 Cases" (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC1315791) . Transactions of the American Ophthalmological Society.
37: 395–403. PMC 1315791 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1315791) .
PMID 16693194 (https://pubmed.ncbi.nlm.nih.gov/16693194) .

33. Ophthalmology in Malta, C. Savona Ventura, University of Malta, 2003 (http://staff.um.edu.mt/csav1/hist

ory/ophthalmology.pdf) Archived (https://web.archive.org/web/20070701021929/http://staff.um.edu.
mt/csav1/history/ophthalmology.pdf) 2007-07-01 at the Wayback Machine.

34. Gupta, UC and Preobragenski, W (1964), Trachoma in India—Endemicity and Epidemiological study, Indian
Journal of Ophthalmology, Volume 12, issue 2, pages 39–49.

35. Taylor, Hugh R. (2001). "Trachoma in Australia" (https://www.mja.com.au/journal/2001/175/7/trachoma-

australia) . Medical Journal of Australia. 175 (7): 371–372. doi:10.5694/j.1326-5377.2001.tb143622.x
(https://doi.org/10.5694%2Fj.1326-5377.2001.tb143622.x) . PMID 11700815 (https://pubmed.ncbi.nlm.
nih.gov/11700815) . Archived (https://web.archive.org/web/20131202230103/https://www.mja.com.a
u/journal/2001/175/7/trachoma-australia) from the original on 2 December 2013.
36. "India now free of infective trachoma, says JP Nadda" (http://www.newindianexpress.com/nation/2017/d
ec/09/india-now-free-of-infective-trachoma-says-jp-nadda-1722546.html) . The New Indian Express.
Retrieved 21 December 2017.

37. "tra·cho·ma" (http://www.thefreedictionary.com/Tracoma) . The American Heritage Dictionary of the

English Language, Fourth Edition. TheFreeDictionary. Retrieved 19 January 2014.

External links

CDC Disease Info trachoma (https://www.cdc.gov/nczved/divisions/dfbmd/diseases/trachoma)

Celia W. Dugger (31 March 2006), "Preventable Disease Blinds Poor in Third World" (https://w
ww.nytimes.com/2006/03/31/world/africa/preventable-disease-blinds-poor-in-third-world.ht
ml) , The New York Times

Photographs of trachoma patients (https://web.archive.org/web/20061130072940/http://web

eye.ophth.uiowa.edu/eyeforum/atlassearch1.htm?appSession=65715523547772)

Trachoma Atlas (http://www.trachomaatlas.org)

International Trachoma Initiative (http://www.trachoma.org)

Classification ICD-10: A71 • ICD-9-CM: 076 • D

MeSH: D014141 • DiseasesDB: 29100

External resources MedlinePlus: 001486 •

eMedicine: oph/118 •

Patient UK: Trachoma

Retrieved from
"https://en.wikipedia.org/w/index.php?
title=Trachoma&oldid=1043839337"
 Last edited 14 days ago by SimLibrarian

Content is available under CC BY-SA 3.0 unless

otherwise noted.