The History of Trachoma in Iran

The epidemic and eradication of trachoma in Iran during the past century reflects the evolution of modern medicine and the emergence of public health. To document these events, to recognize key contributions, and to synthesize lessons learned is a social responsibility.

To develop a comprehensive and credible historical review, we assembled a multidisciplinary team including a medical historian (JRO), disease control authorities from the Ministry of Health (AM and SFM), expert faculty from diverse fields (SFM, EA, SMM, and NB), the principal investigator of the most recent field survey (MK), and a prominent contemporary figure in Iran's Trachoma control efforts (JA). We reviewed institutional records, government health reports, and medical faculty documents archived in the National Library and Archives of Iran; analyzed the published scientific papers; interviewed the late Professor Hormoz Chams on key events and milestones; and consulted Iran's 2019 official report on trachoma elimination. We conducted documentary analysis and organized historical developments chronologically. Key actors, institutions, and interventions were identified to reconstruct the evolution of clinical practice, community investigations, and public health programs.

This review begins with a concise overview of the ancient and global history on trachoma, followed by a focused account of its history in Iran-more detailed from the late Qajar to the Pahlavi period, and less so for the post-1979 Iranian revolution era. Recognized institutional players include Dar ul-Funun; Majlis-e Hefz al-Sehheh; Farabi Hospital and its Ophthalmology Chair; urban trachoma clinics and ministerial offices; the Parasitology Chair and Research Department, later the Institute of Parasitology and Malariology at the Medical School and later the School of Public Health at the Tehran University; the Social Services Organization; and the National Consultative Assembly. The Anglo-Persian Oil Company and its hospitals, the Red Lion and Sun Society, school-based health, and eventually the national primary health network all played important roles over time. Developments in medical specialization (ophthalmology and microbiology) and vocational education (community health and nursing) contributed to the efforts. Early generations of ophthalmologists, schoolteachers, nurses, disease and environmental control officers, and later community health workers, worked alongside microbiologists and public health experts. The evolution of treatment is traced from eye irrigation and lunar caustic chemoablation, to diathermocoagulation, and finally antibiotic therapy. While Iran never implemented mass drug administration, widespread free access to tetracycline eye ointment may have had a meaningful impact in the final stages. The Construction Jihad's major initiatives in the 1980s provided a leap forward in access to safe water and sanitation. Meanwhile, improvements in literacy and personal hygiene-especially among children-further transformed the landscape. Finally, the story includes notable individuals, such as the figure "the Kind Stranger".

Trachoma was the leading cause of blindness in Iran in the 1920s. Conservative projections suggest that active trachoma was eliminated between 1995 to 2000, and trachomatous trichiasis was corrected or fading by 2010-2015. The World Health Organization formally certified Iran's control of trachoma in 2018. This achievement demonstrates the impact of legislation and political accountability on national health and illustrates how broader socioeconomic progress contributes to health outcomes. Trachoma remains a compelling subject for continued inquiry and historical investigation.