River blindness
Symptoms, transmission, and current treatments for filarial diseases
River blindness
Symptoms, transmission, and current treatments for filarial diseases
What are filarial diseases?
Filarial diseases are caused by parasitic worms that are transmitted by the bite of blood-feeding insects. This debilitating group of diseases includes river blindness and lymphatic filariasis (commonly known as elephantiasis).
What is river blindness?
Onchocerciasis, commonly known as river blindness, is a filarial disease caused by the parasitic nematode worm Onchocerca volvulus. People are infected by worms transmitted by the bite of blood-sucking blackflies, which breed in fast-flowing rivers.
River blindness is not usually fatal, but it can cause devastating disability. In the human body, the adult worms produce embryonic larvae (microfilariae) that migrate to the skin, eyes and other organs. The worms can cause severe itching, disfiguring skin conditions, impaired vision, and irreversible blindness.
Efforts to eliminate river blindness are hampered in some areas by another parasitic infection: Loiasis (also known as Loa loa or ‘African eye worm’). People living with a high amount of Loa loa larvae (microfilariae) in their blood are at risk of life-threatening complications if they receive ivermectin, the most common treatment for river blindness.
What is the impact of river blindness?
- 250 million people at risk
- 1.15 million people with vision loss
- 99% of people infected live in 26 African countries, predominantly in West and Central Africa
- 14.6 million people suffer from filarial skin diseases
What are current treatments for river blindness?
Current strategies to control river blindness are based on repeated mass drug administration (MDA) of ivermectin, and occasionally moxidectin, to almost everyone living in an affected area. These efforts are guided by the country’s national control programmes and supported by international organizations, such as the World Health Organization (WHO), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the Task Force for Global Health. The drugs kill juvenile worms and temporarily sterilize adult worms. The adult worms remain alive in the body and eventually produce new offspring, often before the next MDA takes place. As a result, MDA campaigns must be repeated annually or semi-annually for 10 to 15 years.
Ivermectin is safe and has been used widely; however, it:
- Requires many years of repeatedly taking the drug to reduce disease burden and eventually achieve elimination
- Cannot be used in areas with high levels of Loa loa (African eye worm) infection because it can result in severe and potentially fatal side effects
- Must be avoided during pregnancy, and there is currently no formulation suitable for small children
- Only partly improves or prevents river blindness symptoms such as itching, dermatitis, and blindness because people continue to be affected by the adult worms living in their bodies.
What new treatments for river blindness are needed?
WHO has set targets for the elimination of river blindness in 12 countries by 2030 in its NTD Roadmap. Although countries are making steady progress and elimination programmes continue, WHO also notes that the lack of effective treatments is making reaching the targets more difficult.
New drugs that can kill both adult and juvenile worms and are safe for people who also have Loa loa are urgently needed.
We aim to deliver a safe, effective, affordable, and field-adapted drug that can kill both adult (a macrofilaricide) and juvenile (a microfilaricide) filarial worms and be used for prevention or individual treatment.
Find out about our work developing treatments for river blindness.
How do you get river blindness?
- Insect bites: river blindness is transmitted through the bite of blackflies carrying Onchocerca volvulus worms
What are the symptoms of river blindness?
River blindness is not usually fatal, but if left untreated, it causes long-term suffering, chronic illness, and permanent disability, including:
- visual impairment and blindness
- severe itching
- dermatitis
- nodules under the skin (around adult worms)
How is river blindness diagnosed?
- River blindness is diagnosed by identifying juvenile worms in skin snips.
- In patients with nodules in the skin, the nodule can be surgically removed and examined for adult worms.
- Infections in the eye can be diagnosed with a slit-lamp examination of the front part of the eye where the larvae or the lesions they cause are visible.
Antibody tests are available but have limited use in areas where river blindness is commonly found because they cannot differentiate between past and current infection. Several rapid diagnostic tests (RDTs) are under development, but currently lack the sensitivity and specificity needed for use in national elimination programmes.
Accurate diagnosis of Loa loa coinfection is important when considering treatment with ivermectin, since rapid killing of large numbers of juvenile Loa loa worms can cause serious and potentially fatal side effects.
More information
Last updated: October 2026
‘I depend totally on my wife. She feeds and dresses me, and she also doesn’t have a job. After I lost my sight, we couldn’t send any of our children to school.’
Akoyo, from the Democratic Republic of the Congo, used to be a fisherman. After contracting river blindness, he started having difficulties seeing and lost his sight completely the following year. His son Aito also has the disease and had to leave school to help take care of his father.
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