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To review current practices for trachoma treatment with a focus on recent studies, particularly those discussing trachoma trichiasis surgery.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.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.