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Trachoma - External and Internal Eye
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Trachoma - External and Internal Eye

Contributors: Reaford Blackburn Jr, MD, Sagar A. Vaidya MD, PhD, Zaw Min MD, FACP, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed


Trachoma, also known as granular conjunctivitis or Egyptian ophthalmia, is a bacterial infection of the eye caused by Chlamydia trachomatis serovars A, B, Ba, and C. The organism is found in eye secretions and spread by direct contact, contact with fomites (eg, clothing), and flies. Trachoma is predominately found in developing countries, particularly sub-Saharan Africa and Asia. The initial infection is frequently acquired before 2 years of age, and recurrent infection causes chronic inflammation with scarring of the cornea, which can lead to blindness if untreated. Worldwide, trachoma is the most preventable cause of infectious blindness.

Clinical manifestations of trachoma can be divided into 2 clinical phases: active trachoma and cicatricial disease.

Active trachoma – Active trachoma is mostly seen in young children and occurs after a 5-10 day incubation period from exposure. While most individuals are asymptomatic, signs and symptoms can include the following:
  • Swelling of the eyelids from formation of follicles on the superior tarsal conjunctiva
  • Eye irritation
  • Mucopurulent discharge
Cicatricial disease – The later stage of trachoma, known as cicatricial disease, is secondary to repeated episodes of infection and is mainly seen in adults. Clinical features include the following:
  • Marked conjunctival inflammation
  • Entropion – Conjunctival scarring leading to inward turning of the eyelid
  • Trichiasis – Ingrown eyelashes from entropion causing irritation of eyeball and cornea
  • Corneal edema, ulceration, and scarring due to trichiasis, resulting in corneal pannus (inflammatory vascular tissue) followed by corneal opacity, and eventually blindness


A71.9 – Trachoma, unspecified

2576002 – Trachoma

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Differential Diagnosis & Pitfalls

The important differential diagnoses are as follows:
  • Viral conjunctivitis (eg, adenovirus) – Acute, self-limited.
  • Inclusion conjunctivitis – Usually in an area where trachoma is non-endemic; will isolate the genital serovars of C. trachomatis (serovars D through K).
  • Bacterial conjunctivitis (eg, Streptococcus pneumoniae, Moraxella spp.) – Sometimes concurrent upper respiratory tract infection.
  • Toxic conjunctivitis – Cosmetics, chemical exposure.
  • Trauma (eg, Corneal abrasion) – May cause corneal scarring or clouding but can be differentiated based on history.
  • Vernal keratoconjunctivitis – May have a history of atopy.
  • Oculoglandular syndrome of Parinaud (eg, from Cat-scratch disease or Tularemia) – Unilateral.
  • Ocular cicatricial pemphigoid – Look for involvement of the mouth and gums.

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Last Updated:08/19/2021
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Trachoma - External and Internal Eye
A medical illustration showing key findings of Trachoma (Active) : Eye pain, Blurred vision, Photophobia, Eyelid edema, Preauricular lymphadenopathy, Mucopurulent eye discharge
Clinical image of Trachoma - imageId=2841515. Click to open in gallery.  caption: 'White scarring of the conjunctiva secondary to trachoma.'
White scarring of the conjunctiva secondary to trachoma.
Copyright © 2024 VisualDx®. All rights reserved.