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.

How does trachoma cause blindness?

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.

What is the SAFE strategy?

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.

What is the azithromycin donation programme?

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%.

Why do women suffer more from trachoma?

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.

Which countries have eliminated trachoma?

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.

What is trichiasis surgery?

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.

How does poverty perpetuate trachoma?

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.

How does GMJ News cover trachoma?

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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Trachoma

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Trachoma — caused by repeated infection with Chlamydia trachomatis — is the world's leading infectious cause of blindness, responsible for the irreversible visual impairment of approximately 1.9 million people and active infection in approximately 137 million (WHO). Trachoma disproportionately affects the poorest and most marginalised communities in 44 endemic countries — where inadequate WASH, crowded housing and fly contact perpetuate transmission. WHO's SAFE strategy — Surgery for trichiasis (in-turned eyelashes), Antibiotics (azithromycin), Facial cleanliness and Environmental improvement — is proving remarkably effective, with 11 countries achieving elimination since 2010.

Key messages

1.9 million irreversibly blind

Trachoma is the world's leading infectious cause of blindness, responsible for the irreversible visual impairment of approximately 1.9 million people — in a disease that is entirely preventable with the SAFE strategy (WHO).

SAFE strategy

WHO's SAFE strategy — Surgery for trichiasis, Antibiotics (azithromycin mass drug administration), Facial cleanliness and Environmental improvement — is the evidence-based framework proven to eliminate trachoma, validated in 11 countries since 2010.

Azithromycin mass treatment

Annual community-wide azithromycin (Zithromax) mass drug administration — donated by Pfizer since 1996 — reduces trachomatous inflammation and clears C. trachomatis infection, interrupting the transmission cycle that leads to progressive scarring and blindness.

Women and children most affected

Women are blinded by trachoma at twice the rate of men — because they care for children and have more exposure to infected secretions. Children under 5 have the highest rates of active trachoma and are the primary reservoir for transmission.

11 countries eliminated

Eleven countries have achieved WHO-validated elimination of trachoma as a public health problem: 6 in Africa, Mexico, Islamic Republic of Iran, Morocco, Oman and Lao PDR — demonstrating that elimination is achievable globally.

2030 target

WHO targets global elimination of trachoma as a public health problem by 2030 — targeting <5% TF prevalence in children 1-9 years and <0.2% trichiasis prevalence in adults in all endemic districts.

Key statistics

1.9M

people irreversibly blinded by trachoma

WHO

137M

with active trachoma infection

WHO

1.4M

needing trichiasis surgery

WHO

endemic countries

WHO

countries achieved WHO-validated elimination

WHO 2023

higher blindness rate in women vs men

WHO

Trachoma-endemic districts achieving elimination targets — WHO NTD Roadmap

Source: WHO GET2020 Alliance. Progress accelerating; Africa has the majority of remaining burden.

Glossary of key terms

Trachomatous trichiasis (TT)
WHO/GET2020The advanced scarring stage of trachoma — in which conjunctival scarring causes inturned eyelashes (trichiasis) that abrade the cornea with every blink, causing pain, photophobia, corneal opacity and blindness. Treated with bilamellar tarsal rotation (BTR) surgery.

Trachomatous inflammation–follicular (TF)
WHOThe active infection stage used for epidemiological assessment — defined by five or more follicles in the upper tarsal conjunctiva. TF prevalence >5% in children aged 1-9 years triggers MDA implementation in a district.

SAFE strategy
WHO/GET2020Surgery (for trichiasis), Antibiotics (azithromycin MDA), Facial cleanliness (washing faces to remove secretions) and Environmental improvement (latrines, water access reducing fly-eye contact). All four components must be implemented for sustainable elimination.

Azithromycin MDA
WHO/PfizerAnnual mass treatment with azithromycin (a single oral dose — 1g for adults, 20mg/kg for children) in districts with ≥5% TF prevalence — kills C. trachomatis and clears active infection. Pfizer donates Zithromax for trachoma programmes through the International Trachoma Initiative.

Bilamellar tarsal rotation (BTR)
WHO/IAPBThe WHO-recommended trichiasis surgery — rotating the tarsal plate to evert the lid margin and direct lashes away from the cornea. Performed under local anaesthesia by trained mid-level ophthalmic personnel at community level.

GET2020 Alliance
WHOGlobal Elimination of Trachoma by 2020 (GET2020) — the WHO-coordinated partnership for trachoma elimination. Target was revised to 2030 due to remaining burden; the Alliance coordinates national programmes, surveillance, M&E and advocacy.