What is trachoma and how do you get it?

Trachoma is an eye infection caused by Chlamydia trachomatis that spreads through contact with eye or nose secretions, shared cloths or towels, and eye-seeking flies. Repeated infections in childhood scar the inner eyelid, turning lashes inward and damaging the cornea. Crowding, poor water access, and limited sanitation increase spread.

Is trachoma contagious?

Yes. Trachoma spreads person-to-person through hands, shared items like towels, and flies that contact eye discharge. Keeping children’s faces clean, frequent handwashing, and treating infected people—sometimes whole communities in endemic regions—reduces transmission.

How serious is trachoma?

Trachoma can lead to blindness if repeated infections cause scarring that turns eyelashes inward and scratches the cornea. Early antibiotic treatment and, when needed, eyelid surgery prevent most vision loss. Advanced corneal scarring causes permanent visual impairment.

How is trachoma different from other pink eye?

Unlike common “pink eye,” trachoma often causes follicles on the upper inner eyelid and, after years, scarring that turns lashes inward. Most pink eye is viral or allergic and doesn’t cause scarring or trichiasis. Travel or residence in endemic regions raises suspicion for trachoma.

How is trachoma treated?

Active trachoma is usually treated with a single dose of oral azithromycin; in endemic areas, entire communities may be treated. Eyelid surgery corrects lashes rubbing the eye (trichiasis). Good face-washing and sanitation help prevent spread. In the US, treatment follows these principles on an individual basis.

Can trachoma go away on its own?

Early infections may clear, but repeated infections are common and lead to scarring that does not go away. Treating active cases and improving hygiene interrupt the cycle and protect vision. Eyelid surgery is needed if scarring causes lashes to turn inward.

How long does it take to recover from trachoma treatment?

After a single dose of azithromycin, eye irritation typically improves over days to weeks. If eyelid surgery is needed for trichiasis, healing usually takes 1–2 weeks, with vision comfort improving as lashes no longer rub the cornea. Follow-up is important to detect recurrence.

Should family members be treated if someone has trachoma?

In endemic settings, household and community members are often treated to stop spread. In non-endemic areas like the US, clinicians may assess and treat close contacts based on exposure risk and public health guidance. Good hygiene and not sharing towels are essential.

Can children get trachoma?

Yes. Children are the main reservoir for active trachoma and often have few symptoms beyond eye discharge. They can be treated safely with weight-based azithromycin. Keeping faces clean and improving sanitation are key to protecting children in affected areas.

Can trachoma come back after surgery?

Yes. Eyelashes can regrow or lids can scar further, leading to recurrent trichiasis that may need repeat epilation or surgery. Regular follow-up helps catch recurrence early and protect the cornea from renewed rubbing.

Is trachoma common in the United States?

No. Trachoma has been eliminated as a public health problem in the US. Sporadic cases occur in people who have lived in or traveled to endemic countries. If you develop persistent red eye after travel, get an eye exam.

What is trachoma? Symptoms, causes and treatment

Name: What is trachoma? Symptoms, causes and treatment
Creator: Aleksey Sologub
Published: 2023-11-13

Overview

By Aleksey Sologub, Editor-in-Chief

Trachoma is a chronic keratoconjunctivitis caused by ocular infection with Chlamydia trachomatis serovars A, B, Ba, and C. Repeated infections in childhood trigger chronic inflammation that scars the conjunctiva (inner eyelid), leading to entropion (inward-turning lid), trichiasis (lashes rubbing the cornea), corneal opacity, and preventable blindness. Diagnosis is clinical using the WHO simplified grading system; nucleic acid amplification testing (NAAT) is used selectively in non-endemic settings. Management follows the WHO SAFE strategy: eyelid Surgery for trichiasis, Antibiotics (azithromycin) for active disease, Facial cleanliness, and Environmental improvement.

Key Points

Trachoma is a chronic ocular infection by C. trachomatis (serovars A–C) that causes scarring trachomatous disease after repeated exposures, usually beginning in childhood.
Characteristic findings include upper tarsal conjunctival follicles, superior limbic pannus, Herbert pits, and later cicatricial changes causing trichiasis and corneal opacity.
Diagnosis is clinical in endemic settings using the WHO simplified grading (TF, TI, TS, TT, CO); NAAT is reserved for atypical cases in non-endemic areas.
First-line antibiotic for active trachoma is single-dose oral azithromycin (off-label for trachoma in the US); tetracycline 1% ophthalmic ointment is an alternative per WHO.
The SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) reduces transmission and progression at individual and community levels.
In the US, trachoma has been eliminated as a public health problem; sporadic cases occur among travelers or migrants from endemic regions.

Anatomy and Physiology

The palpebral (tarsal) conjunctiva lines the inner eyelids and contains lymphoid tissue that can form follicles. Goblet cells within the conjunctival epithelium produce mucins that maintain tear film stability. The superior tarsal conjunctiva is most affected in trachoma. The limbus (corneoscleral junction) develops follicles and scarring (Herbert pits). Chronic inflammation and scarring distort the tarsal plate, invert the lid margin, and direct lashes toward the cornea, abrading the epithelium and promoting neovascularization (pannus) and opacity.

Etiology

Pathogen: Chlamydia trachomatis, serovars A, B, Ba, C.
Transmission: Eye-to-eye via fingers, fomites (towels, cloths), and eye-seeking flies (Musca sorbens). High transmission in settings with poor water access, crowding, and inadequate sanitation.
Risk factors: Young age (preschool children), close contact in households, limited face-washing resources, arid/dusty environments, and cohabitation with untreated active cases.

Pathophysiology

Primary infection produces follicular conjunctivitis with lymphoid hyperplasia and mucopurulent discharge. Recurrent infections cause chronic inflammation, goblet cell loss, and subepithelial fibrosis (scarring). Scarring contracts the tarsus, causing entropion and trichiasis; lashes abrade the cornea, leading to epithelial breakdown, bacterial superinfection, pannus, and stromal scarring. Characteristic sequelae include Arlt line (horizontal tarsal scar) and Herbert pits (depressed limbal scars from healed follicles). Progressive trichiasis and corneal opacity cause visual impairment and blindness.

Epidemiology

Globally, trachoma remains the leading infectious cause of blindness. The World Health Organization reports ongoing endemicity in dozens of countries, with more than one million people living with vision loss attributable to trachoma and over one hundred million at risk of infection [1]. In the United States, trachoma has been eliminated as a public health problem; cases are rare and typically occur in people who have lived in or traveled to endemic regions [2,3].

Classification

WHO simplified grading (field-applicable):

TF (Trachomatous inflammation—follicular): ≥5 follicles (≥0.5 mm) on the upper tarsal conjunctiva.
TI (Trachomatous inflammation—intense): Pronounced inflammatory thickening obscuring more than half of deep tarsal vessels.
TS (Trachomatous scarring): Conjunctival scarring of the tarsal conjunctiva.
TT (Trachomatous trichiasis): At least one lash touches the globe or evidence of recent epilation due to rubbing.
CO (Corneal opacity): Corneal opacity blurring the pupil margin, likely to impair vision.

Symptoms and Signs

Active inflammatory trachoma (children; TF/TI)

Symptoms: Mild ocular irritation, tearing, photophobia, discharge; may be asymptomatic.
Signs: Follicles on the upper tarsal conjunctiva; papillary hypertrophy; limbal follicles; superficial corneal pannus superiorly; Herbert pits at the limbus after healing; mucopurulent discharge.

Cicatricial trachoma (adolescents/adults; TS)

Symptoms: Dryness, irritation, foreign-body sensation; fluctuating blurred vision.
Signs: Tarsal conjunctival scarring (e.g., Arlt line), distortion of lid margin, meibomian gland dropout, punctate keratopathy.

Trichiasis and corneal involvement (TT/CO)

Symptoms: Foreign-body sensation, pain, photophobia, decreased vision.
Signs: In-turned lashes rubbing the cornea, corneal epithelial defects, bacterial keratitis, corneal pannus and scarring, opacity over the visual axis.

Complications

Entropion and trichiasis (recurrent or progressive)
Corneal abrasion, bacterial keratitis, ulceration, and scarring
Corneal opacity and irreversible vision loss/blindness
Dry eye from goblet cell loss and meibomian gland dysfunction
Secondary infections (bacterial conjunctivitis, keratitis)

Diagnosis

Clinical evaluation

History: Exposure risk (residence/travel in endemic regions, household contacts with red eyes), age, hygiene and water access, prior episodes.
Examination: Evert upper lid; assess for follicles (≥0.5 mm), papillary hypertrophy, tarsal scarring, entropion/trichiasis, Herbert pits, pannus, and corneal opacity. Grade using WHO simplified system.
In non-endemic settings, consider alternative diagnoses and document features distinguishing trachoma from other follicular or cicatricial conjunctivitides.

Imaging and laboratory testing

Laboratory confirmation is not required in endemic settings for routine management.
NAAT (PCR) from conjunctival swab can confirm C. trachomatis in atypical cases or surveillance studies in non-endemic regions [2]. Most clinical NAATs do not serovar-type (A–C vs D–K).
Historical methods (Giemsa-stained conjunctival scrapings for inclusion bodies, culture in cell lines) are rarely used.

Differential diagnosis

Entity	Distinguishing features
Adenoviral follicular conjunctivitis	Acute onset, watery discharge, preauricular lymphadenopathy, pharyngitis, often bilateral; subepithelial corneal infiltrates; self-limited.
Adult inclusion conjunctivitis (C. trachomatis D–K)	Sexually active adults; chronic unilateral/bilateral mucopurulent conjunctivitis; concomitant urethritis/cervicitis; fewer limbal signs; no classic cicatricial progression.
Allergic conjunctivitis (seasonal/perennial)	Intense itching; papillary reaction predominates; atopy history; stringy mucus; no scarring or trichiasis.
Molluscum contagiosum–related conjunctivitis	Umbilicated lid margin lesion; chronic follicular reaction ipsilateral; resolves with lesion curettage.
Vernal keratoconjunctivitis	School-age boys; giant papillae on upper tarsus; Horner-Trantas dots; atopy; seasonal flares; corneal shield ulcers possible; no infectious transmission.
Blepharitis/meibomian gland dysfunction	Lid margin crusting, telangiectasia; burning, fluctuating vision; no follicles or limbal pits; chronic dry eye features.
Neonatal inclusion conjunctivitis	Onset days 5–14 after birth; eyelid edema, purulent discharge; perinatal exposure; not the trachoma serovars.

Treatment

Medical management

Antibiotics for active trachoma (TF/TI)
- Azithromycin: 20 mg/kg PO as a single dose (max 1 g). Adults commonly receive 1 g PO once. Off-label for trachoma in the US; regimen aligns with WHO recommendations [1]. Treat household contacts in endemic or high-exposure settings as part of community control.
- Alternative (when azithromycin unavailable/contraindicated): Tetracycline 1% ophthalmic ointment applied to both eyes bid for 6 weeks per WHO [1]. Availability in the US is limited; local alternatives may require infectious disease/ophthalmology consultation.
Adjunctive care
- Lubricants for surface symptoms; lid hygiene; epilation (temporary) to protect the cornea until definitive surgery.
- Manage secondary bacterial conjunctivitis or keratitis per standard care.
Public health
- In endemic areas, mass drug administration (MDA) with azithromycin targets entire communities to interrupt transmission per WHO criteria [1,4].

Procedural and surgical management

Trichiasis/entropion
- Eyelash epilation: Temporizing; requires frequent repetition; does not correct entropion.
- Definitive eyelid surgery: Tarsal rotation procedures—bilamellar tarsal rotation (BLTR) or posterior lamellar tarsal rotation (PLTR)—realign the lid margin and relieve lash-corneal contact; reduces risk of corneal damage [5].
- Recurrent focal trichiasis: Electrolysis or cryotherapy to offending follicles may be used where surgical inversion is minimal.
Corneal disease
- Treat epithelial defects and bacterial keratitis promptly to prevent scarring.
- Penetrating or lamellar keratoplasty for visually significant central opacity is rarely indicated and often limited by ocular surface disease and recurrence risk.

Procedural coding (US; verify payer policies):

Repair of entropion (e.g., tarsal rotation): CPT 67921–67924.
Epilation of eyelashes: CPT 67820.

Special populations

Pediatric: Primary reservoir of active trachoma; weight-based azithromycin dosing (20 mg/kg PO once; max 1 g). Azithromycin oral suspension facilitates dosing.
Pregnancy/lactation: Azithromycin is considered acceptable in pregnancy and breastfeeding for chlamydial infections; use for trachoma is off-label in the US. Avoid systemic tetracyclines; topical tetracycline ointment has minimal systemic absorption but limited US availability; consider risks/benefits and alternatives.
Immunocompromised/elderly: Same principles; higher vigilance for secondary infections and poor wound healing after eyelid surgery.

Prognosis

Active disease in children often remits, but repeated infections drive scarring and late complications. Early identification and antibiotic treatment reduce transmission. Effective eyelid surgery for trichiasis lowers the risk of corneal damage, though recurrence of trichiasis can occur over time and may require repeat procedures [5]. Established corneal opacity causes permanent visual loss; keratoplasty outcomes are guarded on a compromised ocular surface.

Prevention and Patient Counseling

SAFE strategy:
- Surgery for trichiasis to prevent corneal damage.
- Antibiotics (azithromycin) for cases and, in endemic areas, for communities.
- Facial cleanliness: Regular face washing in children to remove ocular/nasal secretions that attract flies and spread infection.
- Environmental improvement: Reliable water access, sanitation, reduced crowding, and fly control decrease transmission [1].
Household measures: Avoid sharing towels/cloths; wash hands; promptly evaluate red, irritated eyes in children after travel/residence in endemic regions.
Travel counseling: Travelers to endemic areas should maintain hand/face hygiene and avoid sharing personal items; seek care for persistent red eye.

Link-outs for related conditions:

Chronic lid margin disease can exacerbate symptoms; see our overview of blepharitis and related dry eye at /blog/dry-eye-syndrome.
Secondary bacterial superinfection can occur; see /disease/bacterial-conjunctivitis.
Corneal involvement with abrasion or ulcer warrants urgent evaluation; see /disease/keratitis.
Focal lid lumps (not a feature of trachoma) are discussed at /disease/chalazion.

When to Seek Immediate Care

Sudden decrease in vision, severe eye pain, or light sensitivity.
Eyelashes rubbing the eye (trichiasis) with pain, tearing, or inability to keep the eye open.
A white or gray spot on the cornea, pus, or worsening redness after a recent eye infection.
Symptoms after travel to or residence in a trachoma-endemic area that do not improve within a few days.
Eye injury or chemical exposure.

References

World Health Organization. Trachoma fact sheet. 2024. https://www.who.int/news-room/fact-sheets/detail/trachoma
Centers for Disease Control and Prevention. Trachoma—General information. 2024. https://www.cdc.gov/globalhealth/newsroom/topics/trachoma/index.html
National Eye Institute. Trachoma. 2024. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/trachoma
World Health Organization. WHO guideline: recommendations for discontinuation of mass drug administration and validation of elimination of trachoma. 2022. https://www.who.int/publications/i/item/9789240042564
Rajak SN, Habtamu E, Weiss HA, et al. Posterior lamellar versus bilamellar tarsal rotation for trachomatous trichiasis: a randomized controlled noninferiority trial. Lancet Glob Health. 2018;6(5):e507–e515. doi:10.1016/S2214-109X(18)30086-5

Reviewed: July 2026 Last updated: July 2026

By: [ASSIGN AUTHOR], Senior Medical Writer Medical Reviewer: [ASSIGN MEDICAL REVIEWER]

This article is for informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified eye care professional about your specific condition. If you have sudden vision loss, severe eye pain, or an eye injury, seek emergency care immediately.