A mucous discharge from your eyes attracts pestering flies to your face. The hot and dry African sun irritates your eyes and blurs your vision. Sweeping the dusty floor, fetching water from the distant communal tap, cooking food over smoky fires for your husband and children, and doing laundry by hand all become arduous tasks. The pain intensifies at night because it feels like several ants are running in your eyes, slowly eating at them. Utilizing health services for your condition is impossible since the nearest health clinic is three hours away by foot, you have no money to pay for health services, and your husband will miss his lunch if you go to the clinic. You are illiterate, no one has educated you about proper facial hygiene, and you are unaware that not seeking medical treatment could lead to blindness, which will disable you and your family for the rest of your life.

These are just some the struggles of a mother living with advanced-stage trachoma in Ethiopia. Trachoma, the leading cause of preventable blindness globally, is an infectious eye disease that predominantly affects mothers and children living in rural areas. Many factors contribute to the high prevalence of trachoma among the poor; however, the lack of water for facial hygiene is the most prominent. Trachoma is blinding millions around the world, but the international public health community has failed to devote significant resources to preventing its transmission through improvements in water and facial hygiene. Understanding the role of water in the prevention of trachoma is crucial in moving forward to eradicate this neglected disease.

The bacterium, Chlamydia trachomatis, most commonly linked to sexually transmitted diseases, is the primary pathogen associated with trachoma. Trachoma is transmitted from nasal and ocular discharge by three main routes: direct contact with the eyes of infected individuals; indirect contact with shawls, pillows, towels, bed sheets; and eye-seeking flies that gravitate towards facial secretions and transmit the pathogen. Active trachoma develops where the inflammation from repeated bacterial eye infections scars the inner upper eyelid, causing the eyelashes to become inverted and rub against the cornea. This inversion of eyelashes, known as trichiasis, impairs vision and leads to blindness if left untreated.