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Trachoma

10 Jul 2008

Paul Chinnock

Citation: Wright HR, Turner A, Taylor HR (2008). Trachoma. Lancet; 7;371(9628):1945-54.

Trachoma is an infectious disease responsible, at present, for approximately 3% of the world’s blindness. Worldwide, there are about eight million people irreversibly visually impaired by trachoma. An estimated 84 million cases of active disease are in need of treatment, if blindness is to be prevented. A review recently published in the Lancet attempts to summarize knowledge about the disease and the current thinking on its treatment and control. The authors take an optimistic line, concluding that, with the strategies already in place, blindness due to trachoma can be eliminated by the target date of 2020.

Further information on trachoma is also available from the World Health Organization (WHO).

Note: This article is published in a journal which is not open access. To see the full article a subscription to the Lancet is therefore required. In some developing countries, readers who are based in institutions may be able to access it through the HINARI programme.

Abstract

Trachoma is a keratoconjunctivitis caused by ocular infection with Chlamydia trachomatis. Repeated or persistent episodes lead to increasingly severe inflammation that can progress to scarring of the upper tarsal conjunctiva. Trichiasis develops when scarring distorts the upper eyelid sufficiently to cause one or more lashes to abrade the cornea, scarring it in turn and causing blindness. Active trachoma affects an estimated 84 million people; another 7.6 million have end-stage disease, of which about 1.3 million are blind. Trachoma should stand on the brink of extinction thanks to a 1998 initiative launched by WHO – the Global Elimination of Trachoma by 2020. This programme advocates control of trachoma at the community level with four inter-related population-health initiatives that form the SAFE strategy: surgery for trichiasis, antibiotics for active trachoma, facial cleanliness, and environmental improvement. Evidence supports the effectiveness of this approach, and if current world efforts continue, blinding trachoma will indeed be eliminated by 2020.