**4. Clinical presentation**

Trachoma presents in two phases: the active phase and the cicatricial or scarring phase; however, both phases can coexist concurrently [6]. Active trachoma is characterized by a mucopurulent keratoconjunctivitis [36]. The conjunctival surface of the upper eyelid shows a follicular and inflammatory response. The cornea may have limbal follicles, superior neovascularization also known as pannus, and punctate keratitis [31]. *C trachomatis infection* may occur concurrently with that of other extraocular mucous membranes, e.g. the nasopharynx, leading to a nasal discharge.

Most patients with active trachoma are relatively asymptomatic [11].

The cicatricial phase has characteristic clinical features, which can lead to definitive diagnosis in most cases [7, 37].
