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ABSTRACT Background: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. Methods: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. Results: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). Conclusions: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control. Background epidemiology Brazil 200 2021 Methods analyzed clinicoepidemiological clinico epidemiological investigated Results 125 12 5 12.5 559 55 9 55.9 2019 80 8 0 8.0 COVID19 COVID 19 COVID-1 pandemic mean 50 5.0 2.76%, 276 2 76 (2.76% 95 1.25.2, 1252 1.2 5.2 , 1 1.2-5.2) 59year year 45.0%, 450 45 (45.0% 44.645.4, 446454 44.6 45.4 44 6 4 44.6-45.4) 53.2%, 532 53 (53.2% 52.853.6, 528536 52.8 53.6 52 52.8-53.6) 52.6%, 526 (52.6% 52.253.0. 522530 52.2 53.0 . 52.2-53.0) 100 10 10.0 LesteJaguaribe Leste Jaguaribe regions 98.1%, 981 98 (98.1% 98.098.2. 980982 98.0 98.2 98.0-98.2) Conclusions underreported advances planning monitoring 20 202 12. 55. 201 8. COVID1 COVID- 5. 2.76% 27 7 (2.76 25 1.25.2 1. 1.2-5.2 45.0% (45.0 645 44.645.4 44645 446 44. 454 45. 44.6-45.4 53.2% (53.2 853 52.853.6 52853 528 52. 536 53. 52.8-53.6 52.6% (52.6 253 52.253.0 52253 522 530 52.2-53.0 10. 98.1% (98.1 098 98.098.2 98098 980 98. 982 98.0-98.2 2.76 (2.7 1.25. 1.2-5. 45.0 (45. 64 44.645. 4464 44.6-45. 53.2 (53. 85 52.853. 5285 52.8-53. 52.6 (52. 52.253. 5225 52.2-53. 98.1 (98. 09 98.098. 9809 98.0-98. 2.7 (2. 1.25 1.2-5 (45 44.645 44.6-45 (53 52.853 52.8-53 (52 52.253 52.2-53 (98 98.098 98.0-98 2. (2 1.2- (4 44.64 44.6-4 (5 52.85 52.8-5 52.25 52.2-5 (9 98.09 98.0-9 ( 44.6- 52.8- 52.2- 98.0-