The Alliance for the Global Elimination of Blinding Trachoma was formed in the mid 1990s. The Alliance of country representatives and experts on trachoma suggested a four-pronged approach to eliminate incident trachomatous blindness: surgery for trichiasis, antibiotics to treat the disease, facial cleanliness and environmental improvements to limit disease transmission. The efficacy and effectiveness of the components of this approach have been evaluated, but the strategy as a whole has not been compared with different combinations of its components. The relevant cost-outcome and pharmacoeconomics literature is limited. This article reviews the cost-effectiveness of the approach's components. Furthermore, the article mentions ongoing research that will address the cost-effectiveness of the entire strategy for eliminating a major cause of preventable blindness in the developing world.