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It was with great interest that I read the recent article by al Arab and co-workers.1 This work clearly shows that endemic blinding trachoma continues to be a major health problem in this area of the Nile Delta, quite close to Cairo.
My attention was particularly drawn to the high rate of recurrence among those who had had trichiasis surgery. Overall, 44% of cases who had had surgery had recurrent trichiasis. It would be most interesting to look at the time that had elapsed between surgery and the time of examination. Some have argued that the recurrence rate from trichiasis reflects poor or inadequate surgery. Others have alluded to the fact that the tarsal scarring trachoma is of a progressive nature and that trichiasis is likely to recur because of ongoing scarring, even after otherwise successful surgery. Information of the elapsed time would help explore the scenario.