, Volume 69, Issue 8, pp 953–970 | Cite as

Strategies to Control Trachoma

  • Anu A. Mathew
  • Angus Turner
  • Hugh R. TaylorEmail author
Review Article


Trachoma is a significant public health problem that is endemic in 57 countries, affecting 40.6 million people and contributing to 4% of the global burden of blindness. Repeated episodes of infection from Chlamydia trachomatis lead to long-term inflammation, scarring of the tarsal conjunctiva and distortion of the upper eyelid with in-turning of eyelashes that abrade the surface of the globe. This constant abrasion, in turn, can cause irreversible corneal opacity and blindness. The Alliance for the Global Elimination of Trachoma by 2020 (GET2020) has adopted the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) strategy as the main action against trachoma. Trichiasis surgery reduces the risk of blindness by reversing the in-turning of eyelashes and also improves the quality of life from non-visual symptoms. However, future efforts need to aim at increasing accessibility to surgery and improving acceptance. Antibacterials are required to reduce the burden of infection. Oral azithromycin is as close to the perfect antibacterial as we will get for mass distribution: it is safe, requires only a single oral dose, treatment is usually repeated every 6–12 months, resistance is not seen as a problem, and cost is not a limiting factor with a large donation programme and newer generic versions of the drug. Future focus should be on the details of antibacterial distribution such as coverage, frequency of distribution and target population. The promotion of facial cleanliness through education may be the key to trachoma elimination as it will stop the frequent exchange of infected ocular secretions and thus reduce the transmission of infection. However, innovative methods are required to translate health education and promotion activities into sustainable changes in hygiene behaviour. Environmental improvements should focus on the barriers to achieving facial cleanliness and cost-effective means need to be identified. There are a number of countries already eligible for certification of trachoma elimination and if current momentum continues, blinding trachoma can be eliminated by the year 2020.


Azithromycin Mass Drug Administration Mass Treatment Trachoma Nucleic Acid Amplification Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Anu A. Mathew
    • 1
  • Angus Turner
    • 2
  • Hugh R. Taylor
    • 1
    • 2
    • 3
    Email author
  1. 1.Centre for Eye Research AustraliaUniversity of MelbourneMelbourneAustralia
  2. 2.Royal Victorian Eye and Ear HospitalMelbourneAustralia
  3. 3.Melbourne School of Population HealthUniversity of MelbourneMelbourneAustralia

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