0.5 mm on the upper tarsal conjunctiva Trachomatous inflammation, intense (TI) - Papillary hyperophy and inflammatory thickening of the upper tarsal conjunctiva obscuring more than half the deep tarsal vessels Trachomatous scarring (TS) - Presence of scarring in tarsal conjunctiva. Trachomatous trichiasis (TT) - At least one ingrown eyelash touching the globe, or evidence of epilation (eyelash removal) Corneal opacity (CO) - Corneal opacity blurring pa of the pupil margin SAFE strategy National governments in collaboration with numerous non-profit organizations implement trachoma control programs using the WHO-recommended SAFE strategy, which includes: Surgery to correct advanced stages of the disease; Antibiotics to treat active infection, using Zithromax (azithromycin) donated by Pfizer Inc through the International Trachoma Initiative; Facial cleanliness to reduce disease transmission; Environmental change to increase access to clean water and improved sanitation. Surgery For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the lashes away from the globe. Early intervention is beneficial as the rate of recurrence is higher in more advanced disease. Antibiotic therapy WHO Guidelines recommend that a region should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one to nine year-old children is greater than 10 percent. Subsequent annual treatment should be administered for three years, at which time the prevalence should be reassessed. Annual treatment should continue until the prevalence drops below five percent At lower prevalences, antibiotic treatment should be family-based. Antibiotic selection: Azithromycin (single oral dose of 20 mg/kg) or topical tetracycline (one percent eye ointment twice a day for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is expensive, it is generally used as pa of the international donation program organized by Pfizer through the International Trachoma Initiative. Azithromycin can be used in children from the age of six months and in pregnancy. Facial cleanliness Children with grossly visible nasal discharge, ocular discharge, or flies on their faces are at least twice as likely to have active trachoma as children with clean faces. Intensive community-based health education programs to promote face-washing can significantly reduce the prevalence of active trachoma, especially intense trachoma (TI). If somebody is already infected washing one's face is strongly encouraged, especially a child, in order to prevent reinfection Environmental improvement Modifications in water use, fly control, latrine use, health education and proximity to domesticated animals have all been proposed to reduce transmission of C. trachomatis.">