Trachoma: preventing blindness with a clean face

Ethiopia has the highest trachoma burden of any country in the world. Trachoma is an eye infection that, over years of repeated re-infection, causes eyelashes to turn inward and scrape the cornea until the person goes blind.

It is completely preventable. The old-fashioned way — washing the face daily with soap and water — works. Ethiopia has cut cases dramatically over the last decade with the WHO SAFE strategy: Surgery for advanced cases, Antibiotics, Facial cleanliness, Environmental improvement.

On this page

• How trachoma spreads
• The four stages
• SAFE — the four-part strategy
• What to do at home
• When to go to a health post
• Surgery — for advanced trichiasis

---

How trachoma spreads

The infection is caused by a bacterium called Chlamydia trachomatis (a different strain from the sexually transmitted one). It spreads through:

• Direct contact with the eyes or nose of an infected person
• Sharing towels, cloths, or bedding
• Flies landing on the eyes and moving from person to person
• Contaminated water

Children under 10 are the biggest reservoir. They pass it to each other and to adults in the household. Trachoma-caused blindness usually appears later in life — after years of repeated childhood infections.

The four stages

1. Follicular trachoma (early infection)

• Small bumps (follicles) inside the upper eyelid
• Mild irritation, no pain
• Discharge from the eye

2. Intense inflammatory trachoma

• Red, swollen eyelid
• Thick discharge
• The most contagious stage
• Common in children 3-8 years old

3. Trachomatous scarring

• Scars form on the inside of the eyelid from repeated infections
• Usually in adults who had repeated childhood infections

4. Trichiasis (eyelashes turning inward)

• Scarred eyelids pull lashes to scrape the cornea with each blink
• Constant, sharp pain
• Blindness within years if untreated

By stage 4, only surgery can prevent blindness.

SAFE — the four-part strategy

WHO’s SAFE strategy is what has reduced trachoma in Ethiopia by over 80% since 2010. All four parts matter.

S — Surgery

For trichiasis (stage 4). A 20-minute eyelid procedure straightens the lashes so they don’t scrape the cornea. Done at any government hospital or in trachoma outreach camps. Free.

A — Antibiotics

Azithromycin — a single dose (one tablet for adults, syrup for children) treats active infection.

Ethiopia runs mass drug administration (MDA) campaigns in trachoma-endemic districts — everyone in a village takes azithromycin at once, treating all reservoirs of infection simultaneously. Take it when offered.

F — Facial cleanliness

Wash the face — especially the eyes — at least once a day with soap and water. This is the single biggest thing families can do to break transmission.

E — Environmental improvement

• Latrines instead of open defecation (reduces the fly population)
• Water access closer to home
• Keeping livestock away from where children play

What to do at home

::: doList

Do

• Wash every child’s face and hands at least once a day with soap and water — twice if they’ve been playing outside or with animals
• Wash faces first thing in the morning and before bed
• Give each family member their own towel (or, at minimum, keep the child’s face towel separate)
• Wash towels weekly in soap and water
• Cover any eye discharge with a clean cloth
• Cover food and water containers — reduces flies
• Bury or dispose of animal dung away from where children play
• Use a latrine — flies breed in exposed faeces
• If your village is offered azithromycin MDA — take it, even if no one in the family has symptoms
• Take every child with red or discharging eyes to a health post — early treatment prevents scarring :::

::: dontList

Don’t

• Do not share towels or face cloths between family members
• Do not touch a child’s eyes with dirty hands
• Do not ignore repeated eye infections in children — each one adds scarring
• Do not use traditional preparations in the eye — some are contaminated with bacteria that make it worse
• Do not delay surgery if a health worker has diagnosed trichiasis — every year of delay damages more of the cornea
• Do not skip MDA campaigns — you may not have symptoms but still carry the bacteria :::

When to go to a health post

::: urgentAdvice severity=“urgent”

Urgent advice: take yourself or your child to a health post if you have:

• Eye discharge that lasts more than a few days
• Red, itchy, or painful eyes
• Eyelashes touching or scraping the eye
• A feeling that something is in the eye that won’t come out
• Recurrent eye infections (more than twice in a year)
• Any blurred vision that develops slowly
• Sensitivity to light after long-term eye problems

Trachoma at stages 1-2 clears completely with one dose of antibiotic. Stage 3 stops progression. Stage 4 needs surgery. :::

::: urgentAdvice severity=“emergency”

Emergency — go to a hospital today if:

• Sudden loss of vision
• Severe eye pain with a red eye
• Something has cut or pierced the eye
• Chemical splash in the eye (rinse with water for 20 minutes, then go)

These are not trachoma but they are eye emergencies. :::

Surgery — for advanced trichiasis

Trichiasis surgery is a small procedure done under local anaesthesia:

• Takes 20-30 minutes per eye
• Small numbing injection in the eyelid
• The surgeon repositions the eyelid so lashes point outward
• Stitches dissolve on their own
• Eye patch for a day
• Recovery in 1-2 weeks

Ethiopia has trained thousands of “integrated eye-care workers” to do this operation in local outreach camps. It is free.

After surgery:

• Wash your face daily
• Take antibiotics if given
• Return for check-up at 2 weeks and 6 months
• The other eye may also need surgery — even if it feels okay now

What families of a person with vision loss can do

• Get the whole family checked — trachoma runs in households
• Wash faces daily starting today
• Help the affected person move safely around the house (clear pathways, mark stairs)
• If blindness is total or advanced, ask the health worker about referral to eye-care rehabilitation services and support
• Contact the Ethiopian National Association for the Blind for community support

Was this page useful?

---

Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Trachoma fact sheet 2024; Ethiopian MoH National Trachoma Action Plan; WHO SAFE strategy documentation 2020.

---

Draft notes: ~1100 words · grade 6 (deliberate — many affected are in low-literacy rural households) · isTimeCritical false but both urgent + emergency advice used · Ethiopian context: SAFE strategy explicitly, MDA campaigns, integrated eye-care workers, Ethiopian National Association for the Blind, addresses traditional eye preparations respectfully · Focus on prevention because it works.