Introduction

Trichiasis is a very common eyelid abnormality in which eyelashes are misdirected towards the cornea and conjunctiva that results in irritation. Continuous rubbing of eyelashes against the globe produces a painful sensation and may damage the vision. The eyelid margins are typically in a normal position and just the eyelashes are misdirected. Trichiasis can be divided into focal (limited to a certain area) or diffuse (involving a larger area).

This ocular condition arises when the tarsal plate (from which eyelashes and glands originate) gets damaged resulting in an abnormal orientation of the eyelashes. Abnormally directed eyelashes may result from congenital conditions, trauma, or infections. The posterior movement of eyelashes towards the cornea poses a range of problems, from irritation to ulceration. The prognosis of trichiasis is good if immediate attention is paid with proper follow-up visits.

What Are The Causes And Risk Factors Of Trichiasis?

It can occur in all age groups however most commonly in adults. The eyelids can be misdirected due to multiple reasons which are described as follows:

• Infections
  • Trachoma
    • The most common cause of blindness in developing countries and results from Chlamydia trachomatis infection.
    • It leads to chronic inflammation and scarring of the conjunctiva.
  • Herpes zoster ophthalmicus
    • A viral infection is commonly called shingles that results in a painful rash along the trigeminal nerve distributions.
  • Inflammatory conditions
    • Stevens-Johnsons syndrome
    • Vernal Keratoconjunctivitis
    • Blepharitis
  • Autoimmune conditions
    • Ocular cicatricial pemphigoid
  • Trauma
    • It may result from post-surgical complications e.g postoperative lid retraction.
  • Chemical injury
    • Glaucoma medications
    • Thermal burns
    • Alkali burns

What Are The Signs And Symptoms Of Trichiasis?

The history and examination of suspected patients helps in devising a treatment strategy. It is critical to ask if there is any previous history of severe infections, trauma/burns, or travel to trachoma endemic countries.

After getting a proper history, the following signs and symptoms may be present on exam in trichiasis patients:

• Red-eye
• Foreign body sensation
• Pain and irritation
• Excessive tearing
• Photosensitivity
• Blurry vision
• Corneal ulcers and scars (in severe cases)

Treatment of Trichiasis

Treatment of trichiasis usually involves treating the underlying disease state e.g  trachoma.

1. Medical management
   1. Trichiasis is managed primarily with surgery however medical management may be beneficial.
   2. Artificial tears/lubricants can relieve irritation.
   3. If an autoimmune disease or infection is causing the condition then appropriate medical therapy should be started to treat the underlying etiology.
   4. Some antibiotics e.g. doxycycline have been used to treat recurrent trichiasis.
2. Surgical management
   1. Surgical treatment can result significant improvement and even total resolution. Localized eyelashes which are misdirected may be removed easily in clinic with forceps or with laser ablation, while diffuse trichiasis requires more specialized procedures. Surgical procedures may include:
      • a.i. Eyelash and follicle destruction
        • Mechanical epilation
        • Electrolysis
        • Radiofrequency
        • Cryotherapy
        • Laser ablation
      • a.ii. Eyelash and follicle repositioning
        • Anterior lamellar repositioning
        • Grafts to strengthen posterior lamella and fornix
        • Tarsoconjunctival advancement

Correction of trichiasis stops the progression of visual loss and may improve the existing vision (by subsiding corneal irritation and damage). It should be evaluated and managed by your ophthalmologist.

References

1. Graham, R. H., MD. (2021, July 20). Trichiasis Treatment & Management: Medical Care, Surgical Care, Consultations. Medscape. Retrieved January 9, 2022, from https://emedicine.medscape.com/article/1213321-treatment#showall
2. What Is Trichiasis? (2020, November 10). American Academy of Ophthalmology. Retrieved January 9, 2022, from https://www.aao.org/eye-health/diseases/what-is-trichiasis
3. Srinivasan, A. M. (2015, May 5). Trichiasis: Lashes Gone Astray. Review of Ophthalmology. Retrieved January 9, 2022, from https://www.reviewofophthalmology.com/article/trichiasis-lashes-gone-astray

Author

Eye Surgeons Associates Drs. Zuhair H. Peracha, Manal H. Peracha-Riyaz, Eric Zuckerman, Matthew Pieters, and Leila Siblani are dedicated to excellence in eye care and service. We utilize the latest treatment methods and procedures, including routine eye care, cataract surgery, glaucoma treatment, retinal disease management, diabetic eye treatment, and eyelid surgery.