Yellowish-white dots on the upper lid are one of the symptoms of trachoma, which is an aggregation of confined lymphocytes in the subepithelial tissue of the conjunctiva on the basis of a diffuse infiltrate. Initially, scattered, detailed yellow-white dots appear on the upper lid conjunctiva. Here is how to diagnose yellow-white dots on the upper lid. 1. Acute trachoma: presents with symptoms of acute follicular conjunctivitis, lid redness, highly congested conjunctiva, rough and uneven lid conjunctiva due to papillary hyperplasia, full-faced follicles in the conjunctiva of the upper and lower domes, combined with diffuse corneal epitheliitis and enlarged preauricular lymph nodes. After a few weeks, the acute inflammation subsides and turns into a chronic phase. 2, chronic trachoma: can be due to repeated infection, the course of the disease extended for several years to more than ten years. Although the degree of congestion is reduced, there is diffuse cellular infiltration with subcutaneous tissue, and the conjunctiva is filthy and hypertrophic with papillary hyperplasia and follicular formation (Figure 1), with follicles of varying sizes that can be gelatinous, and the lesions are prominent in the conjunctiva of the superior vault and the superior margin of the lid. The same lesions are also seen in the lower lid conjunctiva and lower dome conjunctiva, and in severe cases may even invade the meniscus wall. Corneal vascular opacity: It is caused by the normal capillary network outside the corneal limbus, which crosses the limbus into the clear cornea, affecting vision and gradually progressing to the pupil area, with cellular infiltration and development of small shallow ulcers, which can form a small corneal surface after healing. In severe cases of cellular infiltration, a hypertrophic flesh-like opacity (pannuscrassus) may form. During the chronic course of the disease, the conjunctival lesions are gradually replaced by connective tissue, forming scarring. The earliest appearance is a horizontal white streak in the inferior lid sulcus of the upper lid conjunctiva, which gradually becomes reticulated, and when the active lesion has completely resolved, the diseased conjunctiva all becomes a white smooth scar. The course and prognosis of trachoma varies depending on the severity of the infection and whether it is recurrent. In mild cases or those without recurrent infections, the disease can heal in a few months, leaving a thin scar or no visible scar on the conjunctiva. In severe patients with recurrent infections, the course of the disease can last for years to more than a decade, and in chronic cases, the disease is often acute when infected by other bacteria and repeated infections. Finally, extensive scarring is no longer infectious, but there are serious complications and sequelae, often resulting in vision loss and even blindness. There are many clinical staging methods for trachoma in order to prevent and treat trachoma and for investigation and research purposes. In 1979, during the discussion at the Second National Ophthalmology Symposium in China, the staging of trachoma was reformulated: Stage I – progressive stage: i.e., the active stage, where both papillae and follicles coexist, with blurred conjunctival tissue in the upper dome and corneal vascular opacities. Stage II – Degenerative stage: from the beginning of scarring until the majority becomes scarred. Only a few active lesions remain until then. Stage III – complete scarring stage: the active lesion disappears completely and is replaced by a scar, which is not infectious. Criteria for grading have also been established, with active lesions (papillae and follicles) classified as mild (+), moderate (++), or severe (+++) grade II, depending on how much of the total area of the upper lid conjunctiva they occupy. Those occupying less than 1/3 of the area were classified as (+), those occupying 1/3 to 2/3 were classified as (++), and those occupying more than 2/3 were classified as (++++). The grading method of corneal vascular opacification was also determined: the cornea was divided into four equal classes, and those with vascular opacification invading up to 1/4 were considered (+), those reaching 1/4 to 1/2 were considered (++), those reaching 1/3 to 3/4 were considered (++++), and those exceeding 3/4 were considered (++++).