Question 1

What is trachoma?

Accepted Answer

Trachoma is a chronic infectious eye disease caused by Chlamydia trachomatis — transmitted through direct contact with eye and nose discharge from infected people, and by flies (Musca sorbens) that feed on facial secretions. Repeated infection causes progressive conjunctival scarring — eventually turning the eyelashes inward (trichiasis), abrading the cornea with each blink, causing blinding corneal opacity. It is the world's leading infectious cause of blindness, affecting 137 million people with active infection.

Question 2

How does trachoma cause blindness?

Accepted Answer

The pathway to blindness from trachoma typically takes 10-15 years of repeated infections: (1) Active infection (TF — trachomatous inflammation follicular) in childhood; (2) Repeated infections cause conjunctival scarring (TS — trachomatous scarring); (3) Scarring contracts the upper eyelid, inverting the lashes (TT — trachomatous trichiasis); (4) Inverted lashes abrade the cornea → corneal opacity (CO) → blindness. Each stage takes years — blindness typically occurs in adulthood, most commonly in women who have had prolonged childhood exposure.

Question 3

What is the SAFE strategy?

Accepted Answer

SAFE is WHO's evidence-based trachoma elimination strategy: Surgery for trichiasis (BTR surgery to prevent further corneal damage — curative for trichiasis, but cannot restore vision already lost); Antibiotics (azithromycin MDA in endemic districts to treat active infection and reduce transmission); Facial cleanliness (washing children's faces to remove secretions and reduce fly-to-eye contact); Environmental improvement (access to clean water and latrines to reduce fly populations and facial contamination). All four components are needed for sustainable elimination.

Question 4

What is the azithromycin donation programme?

Accepted Answer

Pfizer has donated azithromycin (Zithromax) for trachoma elimination since 1996 through the International Trachoma Initiative (ITI) — one of the largest pharmaceutical donations for any disease. Over 700 million treatments have been distributed. Annual community-wide treatment with a single dose of azithromycin clears C. trachomatis from the community. Treatment is typically continued until TF prevalence in children falls below 5%.

Question 5

Why do women suffer more from trachoma?

Accepted Answer

Women are blinded by trachoma at approximately twice the rate of men, for two reasons: (1) Repeated exposure — women care for young children (the primary reservoir of C. trachomatis) and have prolonged contact with infected secretions, sustaining more reinfection cycles; (2) Possibly hormonal differences in conjunctival scarring response. Women in endemic communities may have substantially more conjunctival scarring and trichiasis despite similar early childhood infection rates to men.

Question 6

Which countries have eliminated trachoma?

Accepted Answer

WHO has validated elimination of trachoma as a public health problem in 11 countries: Ghana (2018), Morocco (2016), Gambia (2015), Oman (2012), Iran (2005), Lao PDR (2017), Mexico (2017), Nepal (2018), Cambodia (2019), Myanmar (2020), and Mali (2020) — with more validations expected. These successes demonstrate that elimination is achievable with sustained SAFE implementation and Pfizer azithromycin donation.

Question 7

What is trichiasis surgery?

Accepted Answer

Trachomatous trichiasis (inturned eyelashes) is treated with bilamellar tarsal rotation (BTR) surgery — a 15-minute procedure that rotates the tarsal plate, directing lashes away from the cornea. It can be performed safely by trained ophthalmic nurses and clinical officers at community level. Surgery prevents further corneal damage but cannot restore vision already lost to corneal opacity. Approximately 1.4 million people currently need trichiasis surgery.

Question 8

How does poverty perpetuate trachoma?

Accepted Answer

Trachoma is exclusively a disease of poverty — occurring only in communities without access to clean water, latrines and sanitation. Inadequate water access prevents face washing (removing infectious secretions); absent latrines lead to open defecation that sustains fly populations; crowded housing facilitates transmission. WASH improvements (the F and E of SAFE) address the root causes — but require infrastructure investment beyond health budgets. Trachoma elimination requires water and sanitation alongside medical interventions.

Question 9

How does GMJ News cover trachoma?

Accepted Answer

GMJ News covers WHO GET2020 Alliance elimination progress, azithromycin donation data, SAFE strategy evidence and country validations. Trachoma is part of the GMJ's NTD and eye health coverage — relevant to PHIG's global health advocacy and the Georgian Medical Journal.

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