This publication speaks to global dialogue regarding the definition of the clinical sign trachomatous trichiasis (TT) for the purposes of determining elimination of trachoma as a public health problem, and whether the definition should include the presence of trachomatous scarring (TS). The key finding from this study was that field grading of TS missed a significant proportion of eyes with tarsal conjunctival scarring as graded by experts using a detailed grading system. As such, the authors do not recommend that programmes collect TS data in the field to determine if trichiasis is trachomatous or not.