الفهرس 
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Abstract
Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva.
This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries.
The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.
Tear film BUT reflects the quality and stability of the tear film. Corneal epithelial diseases may be accompanied by some tear film instability due to superficial epithelial abnormalities, even when the tears are otherwise normal. Trachoma is known to cause conjunctival scarring leading to tear film abnormality.
Tear film flow and stability studies were carried out in patients suffering from cicatrizing trachoma by Schirmer test I and tear film break-up-time (BUT) measurements, respectively. Both Schirmer test I and BUT values were decreased significantly (t-test, P less than 0.001) depicting aqueous as well as mucin deficiency and hence, an unstable tear film in this condition.
The provision of surgery to correct TT in the populations most severely affected is a major challenge for the global effort to eliminate trachoma blindness by the year 2020.
Various surgical procedures can be carried out for cicatricial entropion of the upper lid and selection depends on whether the cicatricial process is progressive (Stevens–Johnson syndrome, mucous membrane pemphigoid) or static as in infection (trachoma) or chemical injury. The success rates of various procedures can vary markedly.
For mild cicatricial upper lid entropion with adequate lid closure, bilamellar tarsal rotation and ALR have been advocated as successful procedures.
In 1949, Trabut described rotation of the terminal tarsus by 180 degrees as a method for correcting cicatricial entropion. This procedure was modified by Collin (1989) whereby the posterior lamella is advanced to establish a new lid margin.
Extensive keratinization of the tarsoconjunctiva can be managed with the aid of mucous membrane grafting.
The World Health Organisation has endorsed the use of bilamellar tarsal rotation for the surgical management of trachomatous trichiasis as it has been found to have the lowest trichiasis recurrence rate.
Our study revealed that surgical correction of upper eyelid trachomatous entropion trichiasis has shown a positive effect on the health state of the cornea and tear film. This was deduced from the improvement in BUT and Schirmer I values as well as the tremendous decline in corneal punctate erosions postoperatively. However, the effect of surgery on corneal curvature was negligible.
The results were comparable for the different surgical approaches carried out in our study