Intended for healthcare professionals

Clinical Review Extracts from “Clinical Evidence”


BMJ 2001; 323 doi: (Published 28 July 2001) Cite this as: BMJ 2001;323:218
  1. Denise Mabey, consultant ophthalmologist (,
  2. Nicole Fraser-Hurt, epidemiologistb
  1. a Guy's and St Thomas' Hospital Trust, London SE1 9RT
  2. b Epiconsult Ltd, Nhlangano, Swaziland
  1. Correspondence to: D Mabey


    Definition Active trachoma is chronic inflammation of the conjunctiva caused by infection with Chlamydia trachomatis. The World Health Organization's classification for acute trachoma defines mild trachoma (grade TF) as the presence of five or more follicles in the upper tarsal conjunctiva of at least 0.5 mm diameter. Severe trachoma (grade TI) is defined as pronounced inflammatory thickening of the upper tarsal conjunctiva that obscures more than half of the normal deep vessels. Repeated infection causes scarring trachoma, in which the upper eyelid is shortened and distorted (entropion), and the lashes abrade the eye (trichiasis). Blindness results from corneal opacification, which is related to the degree of entropion or trichiasis.

    Interventions to prevent scarring trachoma by reducing active trachoma

    Likely to be beneficial:

    Promotion of face washing

    Children having a sustained clean face

    Fly control using insecticide

    Antibiotics (versus placebo or no treatment)

    Oral azithromycin (versus topical tetracycline)

    Treatment of scarring trachoma

    Likely to be beneficial:

    Bilamellar tarsal rotation (versus other eyelid surgery), when performed by an experienced operator

    Incidence/prevalence Trachoma is the world's leading cause of preventable blindness and is second only to cataract as an overall cause of blindness.1 Globally, active trachoma affects an estimated 150 million people, most of them children. About 5.5 million people are blind or at risk of blindness as a consequence of trachoma. Trachoma is a disease of poverty regardless of geographical regions. Scarring trachoma is prevalent in large regions of Africa, the Middle East, south west Asia, the Indian subcontinent, and Aboriginal communities in Australia, and there are small focuses in Central and South America.1 In areas where trachoma is constantly present at high prevalence, active disease is found in more than 50% of preschool children and may have a prevalence of 60-90%.2 As many as 75% of women and 50% of men over the age of 45 may show signs of scarring disease.3 The prevalence of active trachoma …

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