The management of trachomatous trichiasis

Trachoma is the cause of one-quarter of world blindness. Corneal damage from trachoma is related to trichiasis, which may affect over 10% of adults in endemic communities. Relief of trichiasis is believed to prevent corneal damage and the provision of community-based lid surgery is a central strategy for trachoma control programs. This strategy is weakened by the dearth of information on the effectiveness of different trichiasis procedures. A systematic review of trichiasis surgery is presented and reports of treatment efficacy are reviewed. Conclusions are drawn as to which procedures seem most appropriate for trachomatous trichiasis in prevention of blindness programmes. It is suggested that further controlled clinical trials of appropriate trichiasis procedures are needed.