Trachoma elimination, approaching 2020.

PURPOSE OF REVIEW: To review current practices for trachoma treatment with a focus on recent studies, particularly those discussing trachoma trichiasis surgery. RECENT FINDINGS: Azithromycin eye drops twice daily for 3 days may be as efficient as oral azithromycin in treating active trachoma. Facial cleanliness and environmental improvement programming should employ a variety of behavior change techniques to give sustained improvements. Posterior lamellar tarsal rotation carries a lower risk for trichiasis recurrence and is more effective in severe trachoma trichiasis than bilamellar tarsal rotation. Tarsoconjunctival incision can play a pivotal role in trichiaisis recurrence. Tarsus-sparing procedures continue to be refined with good success rates. Concurrent correction of lid abnormalities that commonly occur with trachoma trichiasis may maximize the result of surgery. SUMMARY: Better understanding of the pathophysiology of trachoma and postoperative trichiasis recurrence is critical for effective trachoma control. Progressive tarsoconjunctival scarring in trachoma and high recurrence rates following tarsal rotation procedures raise the importance of adopting a procedure that spares tarsus/conjunctiva.

Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities.

AIM: To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion (UCE) correction using anterior lamellar recession (ALR) with addressing the associated conditions including dermatochalasis, brow ptosis, blepharoptosis, and lid retraction. METHODS: Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed. Success was defined as the lack of any lash in contact with the globe, no need for a second procedure, and acceptable cosmesis at the final follow up. RESULTS: Sixty eight patients (97 eyelids) were operated by ALR with simultaneous correction of associated lid problems in each case when necessary. The mean follow-up time was 17.8mo (range, 6.0-24.0mo). Concomitantly, levator tucking was performed in 19 eyelids (19.6%), upper lid retractor recession in 18 eyelids (18.6%), and internal browpexy in 31 eyelids (32.0%). In 95.8% of patients (95%CI: 0.85-0.96), satisfactory functional and cosmetic outcome was achieved with a single surgical procedure. CONCLUSION: Based on the principles of lamellar recession and concurrently addressing the associated lid problems, this approach is an effective and safe treatment of UCE.