Controlling blinding Trachoma: Intervention and pathophysiology studies for scarring disease in Ethiopia and Tanzania

A single operation for trachomatous trichiasis—where scarred eyelids turn lashes inward to scrape the cornea—fails in up to half of patients within a year, and this programme tests two ways to stop that recurrence. Trachoma is the world’s leading infectious cause of blindness, and while mass antibiotic distribution has cut new infections, millions of people already have scarring that requires surgery. The problem is that existing operations often re-scar, leaving people blind anyway. This research tackles that gap head-on. The team will run two large trials in Ethiopia and Tanzania. The first compares two surgical techniques—Bilamellar Tarsal Rotation versus Posterior Lamellar Tarsal Rotation—on 1,000 patients to see which produces fewer recurrences. The second gives 1,000 patients either oral doxycycline or a placebo for one month after surgery, testing whether the antibiotic can dampen the scarring process. A separate cohort of 650 children will be followed for four years to track how scarring develops from childhood, using gene expression analysis and confocal microscopy. If the trials identify a superior procedure or a drug that limits post-surgical scarring, the impact is immediate: a cheap, scalable improvement to a routine eye operation that already exists in dozens of countries. That could prevent tens of thousands of needless blindness cases each year without requiring new infrastructure or expensive equipment.