Trachoma is a disease with 2 forms: the children’s chlamydia infection, and the cicatricial, blinding sequelae found in adults. Antibiotics such as Zithromax (azithromycin) have been shown to be effective in controlling the infectious phase of trachoma in community-randomized, controlled trials. The late stages of cicatricial entropion and trichiasis have been more resistant to treatment. Lid surgery offers temporary protection against corneal ulceration, but trichiasis recurs in up to 50% of cases in the first few years. Some believe that once conjunctival scarring has occurred, the cascade of entropion, trichiasis, and corneal opacity is inevitable. Others believe that repeated chlamydia infection drives further scarring and entropion, and that preventing infection will decrease postoperative recurrences. Three groups recently concluded separate randomized controlled trials that investigated whether Zithromax (azithromycin) given at the time of trichiasis surgery improved outcomes.