The World Health Organisation (WHO) estimated that in 2002, 1.3 million people were blind due to
trachoma, an
eye infection caused by Chlamydia trachomatis. This review examines the evidence behind current strategies to reduce the global burden of
trachoma.
Trachoma disappeared from most western nations before the advent of
antibiotics, probably due to improvements in water, sanitation and hygiene. The current effort to target
trachoma, headed by the WHO and the Alliance for the Global Elimination of
Trachoma by 2020, is called the SAFE (Surgery,
Antibiotics, Facial cleanliness and Environmental improvement) strategy. Surgery for
trachoma is more cost effective than extra-capsular
cataract surgery and can reverse
trichiasis (in-growing eyelashes), but needs to be repeated every few years. A single oral dose of
azithromycin can eliminate
trachoma infection, but cannot be used in infants under 6 months old, and needs to be given every few years in communities with a high prevalence of disease. Improved health education and facial hygiene has been linked to a lower incidence of
trachoma, but the evidence is less clear than for surgery and
antibiotics. Pit latrines and spraying with
permethrin insecticide may reduce the spread of
trachoma via eye-seeking flies.