Trachoma is a chlamydial disease that affects millions of people each year, particularly in developing countries. In the chronic phase, inflammation causes scarring of the conjunctiva followed by dry eye which can result in blindness. Trachoma may cause dryness of the eye by decreasing mucus production and aqueous secretions. Conjunctival impression cytology was carried out to determine the goblet cell population among patients with trachoma. We performed impression cytology on 32 patients with inactive trachoma and 31 age and sex matched controls. Impression cytology showed that the nasal conjunctiva contains the greatest number of goblet cells. Trachoma patients with severe scarring had significantly less goblet cell counts than those with mild scarring (p less than 0.05). In the group of ten patients with severe trachoma and keratinization, there was marked reduction or absence of goblet cells. Trachoma appears to initiate a viscious cycle of conjunctival scarring, mucus deficiency, and chronic conjunctival inflammation.