Trichiasis Recurrence—Why the Surgery Part of Trachoma Control is Still Uncontrolled

Abstract

Trichiasis surgery is a pillar of the World Health Organization (WHO) strategy for trachoma control. Visual acuity improvement and symptomatic relief follow surgery for trichiasis, and non-ophthalmologists have been trained to carry out the surgery in trachoma-endemic communities. However, recurrence of trichiasis following surgery is unfortunately common, which can undermine public confidence in national trachoma programs. Recurrence of trichiasis following surgery is more likely in high-risk patients (those with previous surgery or who have severe entropion). The most common cause appears to be surgeon skill, with large variations in recurrence reported by surgeon. Proper training, standardization, certification, and supervision would reduce adverse outcomes after surgery. Ideally, recurrence should be 10% at one year, or less with post-operative use of a single dose of azithromycin. The post-operative environment, and acquisition of bacterial infection, may also play a role in recurrence of trichiasis, but it is not clear thatChlamydia trachomatisis important. Efforts to ensure good outcomes of trichiasis surgery for trachoma-endemic, and formerly endemic, countries are imperative. Even with control of active trachoma, trichiasis cases will continue to emerge for years. Detection of these cases, proper surgery, and case management are critical to achieving all the goals of the elimination of blinding trachoma.