Trachoma remains the most common cause of preventable blindness in the world. It is found in communities with poor hygiene or sanitation facilities and inadequate access to potable water. The infection is endemic in many tropical and subtropical areas, especially countries in northern and southern Africa, the Middle East, and on the Indian subcontinent. It is transmitted by direct contact or by flies, which act as mechanical vectors. Trachoma presents as conjunctivitis of both the palpebral and bulbar conjunctivae, followed by the formation of lymphoid follicles; the sequelae, entropion, and trichiasis arise as a result of conjunctival scarring, causing corneal damage. Repeated infection and associated bacterial superinfection can result in visual impairment and blindness. The conjunctival epithelium of infected children is the most important reservoir of infection in the affected communities. High chlamydial loads occur in very young children and have been directly correlated with severity of inflammatory changes.
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