Trichiasis

Trichiasis is an acquired condition that is characterized by posterior misdirection of previously normal eye lashes. The misdirected lashes may be diffuse involving the entire lid (diffuse trichiasis) or may involve a small segment of it. The known instances of simple trichiasis are found to be more common than diffuse trichiasis.

Trichiasis is in variation from pseudotrichiasis which occurs secondary to entropion (inward turning of eyelid). Both of these conditions further leads to irritation of cornea and may lead to punctate epitheliopathy. Trichiasis can lead to infectious keratitis, pannus formation or even corneal ulceration.

There are chances of trichiasis that it may be associated with some different conditions like trachoma or severe chronic staphylococcal blepharitis.

Causes of Trichiasis

There are various causes of trichiasis:-

Infectious causes:

• Trachoma.
• Herpes zoster.

Autoimmune Causes:

• Ocular cicatricial pemphigoid.

Inflammatory Causes:

• Stevens-Johnson syndrome
• Vernal keratoconjunctivitis.
• Chronic staphylococcal blepharitis.

Chemical Causes:

• Alkali burns.
• Use of glaucoma eye drops.

Trauma Causes:

• Repair of orbital floor fracture.
• Blepharoplasty (eyelid surgery).
• Repair of ectropion.
• Following enucleation.

Diagnosis of Trichiasis

Diagnosis of trichiasis is basically based on history.

History:

History of following conditions may be elaborated for the diagnosis:-

• Eye infections like trachoma or herpes zoster.
• Trauma or surgery of the lids.
• Chemical or thermal burns.
• Use of glaucoma eye drops.
• Inflammatory conditions like Stevens-Johnson syndrome or chronic blepharitis.
• Ocular cicatricial pemphigoid.

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Symptoms

Symptoms of Trichiasis

Patient may present with symptoms like:

• Irritation of eyes.
• Foreign body sensation in eye.
• Redness of eyes.
• Watering.
• Eye discharge.
• Pain in eyes.
• Increased sensitivity to light.
• Corneal abrasion.
• Corneal ulceration.
• Symblepharon (adhesion of eyelids to the eyeball).
• Loss of normal eyelid margin structures e.g. madarosis (absence or loss of eye lashes).
• Dryness of eyes due to keratinisation.

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Treatment

Management of Trichiasis

Management should be carried out under medical supervision. Management of trichiasis is primarily surgical.

Medical therapy:

• Artificial tears and ointments: Lubricating artificial tears and ointments may decrease the irritant effect of eyelash rubbing against the eyeball.

In addition to the treatment of trichiasis, diseases such as ocular cicatricial pemphigoid and stevens-johnson syndrome require medical therapy of the disease.

Surgical therapy:

• Epilation: Epilation involves mechanical removal of eyelashes with forceps.
• Electrolysis: Eyelash follicle is destroyed by passage of electric current through a fine needle inserted into lash root.
• Cryotherapy: In this procedure, cryoprobe freezes the lash follicles and finishes it. This procedure should be avoided in cases with ocular cicatricial pemphigoid.
• Laser thermoablation: Laser thermoablation can be done to finish eyelash follicles.
• Radiofrequency ablation: Smallest gauge wire is introduced alongside the lash to the follicle for destruction with radiofrequency.