irritation of the cornea by the inward-turning eyelashes — possibly in combination with secondary bacterial infections — eventually leads to blindness. Even before vision is destroyed, the disease is painful and disabling, confining many of those afflicted to their homes.

The WHO is leading a global initiative to eliminate trachoma as a blinding disease by 2020 with a four-part strategy called SAFE: surgery, antibiotics, facial cleanliness and environmental hygiene. While the final three parts of this strategy are targeted at preventing the spread of trachoma, the first part is focused on improving the health and well-being of those with trachoma trichiasis, who are at risk of going blind.

In their review, the Cochrane researchers analyzed the findings from seven studies that compared different approaches to treating trachoma trichiasis.

Three of the studies compared different ways of performing surgery to correct the inward rotation of the eyelids and prevent the eyelashes from rubbing against the cornea. While one trial found that one type of surgery was more effective than another, the other two trials showed little difference.

“There is wide variation in outcomes between different surgeons,” said Yorston. “In view of this variation, I think that either operation can be effective if the surgery is meticulous, but neither operation will work if it is performed by a poorly supervised surgeon with inadequate equipment.”

A study conducted in Gambia found that patients who received postsurgical azithromycin (the same antibiotic that is used for trachoma prevention) did not have better outcomes compared to patients given the usual postsurgical antibiotic, tetracycline eye ointment.

An Ethiopian study that evaluated whether ophthalmologists achieved better surgical outcomes than specially trained ophthalmic assistants found no significant differences in complications or recurrence of trichiasis. And
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