Trachoma: Causes, Symptoms, and Care in Grand Rapids, Michigan

Trachoma is a bacterial eye infection that can lead to vision loss and blindness if it is not treated. While trachoma is rare in the United States and not considered a common eye disease in Grand Rapids, it remains a major cause of preventable blindness worldwide, especially in areas with poor sanitation and limited access to clean water.

Residents of Grand Rapids who travel to or have family in trachoma‑endemic regions (parts of Africa, Asia, and some remote communities globally) should understand how this infection is spread, how to recognize symptoms, and where to seek eye care locally.

What Causes Trachoma?

Trachoma is caused by the bacterium Chlamydia trachomatis. It is closely linked to:

  • Poor personal hygiene
  • Limited access to clean water
  • Overcrowded living conditions
  • Inadequate sanitation and waste disposal

The infection usually affects both eyes. Over many years, repeated infections (often 150–200 episodes over time) can cause:

  • Scarring of the inner eyelid (conjunctiva)
  • Inward turning of the eyelid (entropion)
  • Inward turning eyelashes (trichiasis) that scrape the cornea
  • Corneal scarring, vision loss, and eventually blindness

How Trachoma Spreads

Trachoma is a communicable disease, meaning it can spread from person to person. It is usually transmitted by:

  • Direct contact with infected eye or nasal secretions (for example, wiping a child’s eyes or nose with bare hands)
  • Indirect contact via contaminated items such as:
    • Towels
    • Washcloths
    • Pillowcases and bedding
    • Clothing
  • Flies that land on the eyes or face and carry infected secretions

Children are most commonly affected because:

  • They often have discharge on their faces
  • They are in close contact with other children
  • They may not wash their face regularly

In Grand Rapids, where most homes have running water and sewage systems, the risk of trachoma is very low. However, people who travel to rural or low‑resource areas overseas, or who work in global health or humanitarian settings, may be exposed.

Global and U.S. Context

Trachoma is still common in:

  • Over 40 low‑ and middle‑income countries, especially in rural Africa and Asia
  • Communities with poor sanitation, limited water access, and crowded housing

In many developed nations, including most of the United States, trachoma has largely disappeared due to:

  • Improved housing
  • Access to running water
  • Modern plumbing and sanitation
  • Better public health and hygiene education

The U.S. is considered non‑endemic for trachoma, meaning it is not circulating widely in the general population. Cases that do occur are often related to international travel or past exposure in endemic regions.

Symptoms of Trachoma

Symptoms usually begin 5–12 days after infection. A single episode of trachoma (“inclusion conjunctivitis”) may be mild and resolve within a month or two, but repeated infections cause long‑term damage.

Common signs and symptoms include:

  • Eye irritation or burning
  • Redness of the eyes (conjunctivitis)
  • Watery or mucous eye discharge
  • Swollen eyelids
  • Inflammation inside the upper eyelid
  • Small bumps on the inner eyelid (lymphoid follicles) caused by an immune reaction

Over time, if infections keep recurring, more serious changes can develop:

  • Scarring of the inner eyelid
  • Eyelid turning inward (entropion)
  • Eyelashes rubbing against the cornea (trichiasis)
  • Abnormal growth of blood vessels into the cornea
  • Corneal scarring
  • Gradual vision loss and potentially blindness

Many people with early trachoma may not notice symptoms (asymptomatic), so the condition can go unrecognized unless specifically examined by an eye care professional.

Risk Factors for Trachoma

Globally, trachoma is strongly associated with:

  • Inadequate personal hygiene, especially a dirty face
  • Limited access to safe, functional bathrooms or latrines
  • Lack of regular face‑washing in children
  • Crowded living conditions (for example, several children sharing the same bed)
  • Poor housing conditions and lack of maintenance
  • Limited access to clean water for washing
  • Living in hot, dry, dusty environments where flies are common

In Grand Rapids and across West Michigan, these risk factors are less common due to widespread access to clean water and sanitation. However, poverty, housing insecurity, and limited access to healthcare can still increase the risk for various eye infections and other preventable diseases.

If you or your family travel to trachoma‑endemic areas, maintaining strict face hygiene and avoiding shared towels and bedding are important.

How Trachoma Is Diagnosed

In Grand Rapids, trachoma is uncommon, so many cases would be identified in people with a travel history to affected regions.

Diagnosis typically involves:

  • Medical history
    • Recent or past travel to rural areas in Africa, Asia, or known endemic regions
    • History of repeated eye infections or chronic conjunctivitis
  • Physical examination
    • Eye exam by a primary care provider, optometrist, or ophthalmologist
    • Eversion (flipping) of the upper eyelid to look for:
      • Follicles (small bumps)
      • Scarring of the inner eyelid
      • Inward‑turning eyelashes
  • Laboratory testing (sometimes)
    • An eye swab to test for Chlamydia trachomatis

In most cases, an experienced eye specialist can make the diagnosis by clinical examination alone.

Treatment for Trachoma

Treatment depends on the stage and severity of the disease.

Antibiotic Treatment

For uncomplicated trachoma, the first‑line treatment is usually:

  • A single oral dose of azithromycin (antibiotic)

This medication:

  • Kills the bacteria
  • Allows the body’s natural healing processes to repair the eye

Key points:

  • All household members should be treated if one person is diagnosed, to prevent re‑infection.
  • In areas with widespread infection, entire communities may be treated.
  • Treatment may need to be repeated every 6–12 months in endemic regions.

In Grand Rapids, your provider may coordinate antibiotic treatment through:

  • Your primary care physician
  • An ophthalmologist (eye surgeon)
  • An optometrist working with local health systems such as Spectrum Health or Trinity Health Grand Rapids

Surgical Treatment

In advanced cases, where scarring has caused the eyelid to turn inward and lashes to rub the eye, surgery may be needed to:

  • Correct the eyelid deformity (entropion)
  • Turn the eyelashes outward (relieve trichiasis)
  • Protect the cornea from further damage

These procedures are typically performed by an ophthalmologist. In Grand Rapids, surgical eye care is available through major health systems including:

  • Spectrum Health / Corewell Health eye clinics
  • Trinity Health Grand Rapids
  • Metro Health – University of Michigan Health
  • Mercy Health and affiliated ophthalmology practices

The SAFE Strategy for Trachoma Prevention

The World Health Organization (WHO) promotes the SAFE strategy for trachoma control:

  • S – Surgery
    • For advanced cases with entropion and trichiasis
  • A – Antibiotics
    • Community‑wide treatment with azithromycin in endemic regions
  • F – Facial cleanliness
    • Regular face‑washing, especially in children
    • No visible eye or nasal secretions on the face
  • E – Environmental improvement
    • Improved access to clean water
    • Better sanitation and waste management
    • Reducing fly breeding sites

In Grand Rapids, while trachoma is rare, the F and E components of SAFE are still important for overall community health:

  • Encouraging regular hand and face washing, especially during cold and flu season
  • Maintaining clean, well‑ventilated homes
  • Supporting community efforts to improve housing and sanitation, particularly in lower‑income neighborhoods

Local organizations such as the Kent County Health Department and Grand Rapids Public Health promote hygiene, sanitation, and infection prevention, which indirectly help prevent a wide range of eye and respiratory infections.

Seasonal and Local Considerations in Grand Rapids

Grand Rapids residents face unique environmental factors:

  • Cold, dry winters can cause eye dryness and irritation, which may make any eye infection feel worse.
  • Indoor heating in winter can further dry out the eyes, leading to rubbing and irritation.
  • Spring and summer allergies can also cause red, itchy eyes that may be confused with infections.

While these conditions do not cause trachoma, they can:

  • Make existing eye irritation more noticeable
  • Increase the urge to rub the eyes, which can spread other infections

Using artificial tears, avoiding eye rubbing, and seeking prompt care for persistent redness or discharge are important steps for eye health in West Michigan.

When to See a Doctor in Grand Rapids

Seek medical care promptly if you or your child has:

  • Red, irritated eyes that last more than a few days
  • Eye discharge (mucous or pus)
  • Swollen eyelids
  • Pain in or around the eye
  • Sensation of something “in the eye” that does not go away
  • Vision changes or blurred vision
  • History of travel to trachoma‑endemic areas with any of the above symptoms

Local Care Options

In Grand Rapids, you can get help from:

  • Your primary care doctor or family physician
  • Ophthalmologists (medical eye doctors and surgeons)
  • Optometrists (eye exams, diagnosis, and management of many eye conditions)
  • Eye clinics within:
    • Spectrum Health / Corewell Health
    • Trinity Health Grand Rapids
    • Metro Health – University of Michigan Health
    • Mercy Health and affiliated practices

For community health resources, contact:

  • Kent County Health Department – for information on infectious disease, hygiene, and public health programs
  • Grand Rapids Public Health – for local health education and support services

If you experience sudden vision loss, severe eye pain, or a serious eye injury, go to the nearest emergency department (for example, Spectrum Health Butterworth Hospital) or call 911.

Key Points About Trachoma

  • Cause: Trachoma is caused by the bacterium Chlamydia trachomatis.
  • Transmission: It spreads through direct contact with infected eye or nasal secretions and indirectly via contaminated towels, bedding, or flies.
  • Risk factors: Poor hygiene, crowded living conditions, and limited access to clean water and sanitation.
  • Symptoms: Eye redness, irritation, discharge, swollen eyelids, and eventually scarring and inward‑turning eyelashes that can lead to blindness.
  • Treatment: Antibiotics (often a single dose of azithromycin) and, in advanced cases, surgery to correct eyelid deformities.
  • Prevention: The SAFE strategy—Surgery, Antibiotics, Facial cleanliness, and Environmental improvement.
  • Local relevance: Trachoma is rare in Grand Rapids, MI, but understanding it is important for travelers, global health workers, and families with ties to endemic regions. Maintaining good eye hygiene and seeking prompt eye care are key to protecting vision.

If you live in the Grand Rapids area and have concerns about eye infections or changes in your vision, schedule an eye exam with a local optometrist or ophthalmologist, or speak with your primary care provider for guidance and referral.