Trachoma is highly contagious in its early stages and is transmitted by direct contact with infected persons or articles (e.g., towels, handkerchiefs) and possibly also by flies. It begins as congestion and swelling of the eyelids with tearing and disturbance of vision. The cornea is often involved. If left untreated, scar tissue forms, which causes deformities of the eyelids and, if there is corneal involvement, partial or total blindness. The disease has been effectively treated with tetracycline ointment and with the newer oral drug azithromycin (Zithromax). The World Health Organization began a campaign in 1998 to eradicate the disease worldwide by the year 2020. The strategy includes use of azithromycin and sanitation improvements in water supplies.