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This 15-year-old Ethiopian boy has a long history of recurrent conjunctivitis and eye irritation. When presenting for examination the lashes of his upper lid appear to be in-turned as shown above.

1.	The most likely diagnosis is:
	c -- trichiasis from trachoma This is an example of trichiasis from repeated episodes of conjunctivitis from infection with Chlamydia Trachomatis causing trachoma.  Repeated infection results in scarring and foreshortening of the upper lid palpebral conjunctiva and in-turning of the lid margin and lashes that abrade the cornea.
2.	Which of the following is correct?
	e -- all of the above All of the above are correct. This condition is caused by a chlamydial infection that is treated by tetracycline ointment twice a day for six weeks and also by Azythromycin taken orally.  If untreated, irritation of the cornea by the in-turned lashes can cause corneal clouding and blindness.  This blinding condition occurs most often in young adult women because of their increased exposure to infected children.  The trichiasis can be treated effectively with lid surgery called bilamellar rotation, but control of the infection process by all means available is also required to prevent recurrence.
3.	This boy would benefit from:
	e -- all of the above All of the options are correct.  Control of the environment leading to eradication of trachoma can be achieved by successful adoption of the S.A.F.E. strategy.  This is S. for surgery on the lids for trichiasais; A. for antibiotics to control the infection; F. for face washing to reduce the concentration of the infecting agent; and E. for environmental control including an abundant supply of clean water and proper management of waste products.