Trichiasis results from eyelashes that are misdirected against the ocular surface. This is most often a consequence of eyelid inflammation and scarring, although it can be a presenting symptom of an eyelid margin malignancy as well. Constant irritation can lead to eye pain, vision changes, corneal abrasions, or corneal ulcers. Although this condition is often idiopathic, certain conditions can contribute to this development, such as infection, inflammation, involutional changes, or trauma. Before removing the malaligned contact between the eyelashes and the ocular surface, diagnosis of and understanding the underlying cause of trichiasis is essential.
Patients may present with eye pain, foreign body sensation, eye redness, tearing, vision changes, photophobia, and decreased vision. An ocular examination may show malpositioned cilia, entropion of the upper and/or lower eyelids, conjunctival injection, superficial punctate keratopathy, corneal abrasion, keratitis, keratinization or blindness
Management is dependent on the underlying pathophysiology, the extent of trichiasis, and the type of lashes affecting the globe. If the patient is on a topical prostaglandin drop that may cause eyelash misdirection, they should discuss with their ophthalmologist whether the medicine can be changed.Eye lubrication, contact lenses, and mechanical epilation. Patients with trichiasis secondary to trachoma benefited significantly from trichiasis recurrence from post-op single dose Azithromycin compared to topical Tetracycline for 6 weeks
A study by Ferraz et al. comparing two common surgical approaches to treatment - intermarginal split lamella with graft (ISLG) or lid lamella resection (LLR) - showed that LLR had higher complete success rates, less repeat surgeries, and was a simpler technique (P<0.05).
Many use alternative treatment options secondary to the damage cryosurgery may inflict on surrounding tissue like the lid margin transitional epithelium and tarsus.
This approach is generally reserved for refractory trichiasis. The eyelid margin is incised and a small portion of the posterior margin is removed that contains the malaligned eyelash. Then, this defect is replaced with a buccal membrane graft in the posterior margin to prevent abnormal scarring that can lead to cicatricial entropion.
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