Trichiasis Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 5, 2012
 

Medical Care

The primary treatment of trichiasis is surgical.

  • Lubricants, such as artificial tears and ointments, may decrease the irritant effect of lash rubbing.
  • If a more serious disease (eg, ocular cicatricial pemphigoid, Stevens-Johnson syndrome) is the cause of the lash misdirection, medical therapy should be geared toward that disease.
  • According to West and colleagues, azithromycin has been shown to reduce severe postsurgical trichiasis recurrence rates to 1 year.[4]
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Surgical Care

Many procedures for the repair of trichiasis have been described. The technique used is dependent on the cause of the problem. These procedures can be categorized as lash/follicle destroying or lash/follicle repositioning.

  • Lash and follicle destruction surgery is preferred for segmental or focal trichiasis.
    • Simple epilation with forceps often leaves the lash follicle and usually is only a temporizing measure. When the lash grows back, it often will be short and stiff, and even more irritating.[5, 6]
    • Electrolysis of lashes can be effective, but it often is painful for the patient and tedious for the surgeon.
    • Cryosurgery of lashes and follicles can be very effective, but it has many potential complications.
    • Radiofrequency ablation of lashes and follicles is extremely effective and can be performed quickly and easily at the slit lamp or with surgical loupes and local anesthesia. The smallest gauge wire (eg, Ellman TA1, A8 bendable 1/16th vari tip) is introduced alongside the lash down to the follicle, with the lowest setting that gives an easy introduction of the wire. The machine should be set on cut/coag. A small "core sample" will be missing from the lid margin and will granulate in with minimal scarring. See the image below. Lower lid trichiasis, Ellman radiofrequency follicLower lid trichiasis, Ellman radiofrequency follicle ablation.
    • Argon laser ablation can be effective, but it can be very tedious for both the patient and the surgeon, as well as expensive.
    • According to Moore and colleagues, ruby laser treatment can be a viable and well-tolerated option for the relief of the symptoms of trichiasis.[7]
    • Wedge resection of the lid segment requires a full-thickness resection of the lid margin; in many cases, it may be excessive.
  • Lash and follicle repositioning surgery should be directed toward the anatomical cause of the problem.
    • Entropion: Lower lid retractor reattachment and lateral tarsal strip can be used to repair most cases of horizontal lid laxity and entropion.
    • Posterior lamellar scarring
      • The posterior lamellae and fornix can be lengthened with grafts (eg, mucous membrane, hard palate, cadaveric dermis).
      • A tarsoconjunctival advancement may lengthen the posterior lamellae.
      • Tarsal fracture with full-thickness everting sutures repositions the lashes to point away from the globe.
      • Surgery of the conjunctiva may reactivate ocular cicatricial pemphigoid and should be avoided with this disease.
      • Repositioning of the anterior lamellae may be the method of choice when dealing with ocular cicatricial pemphigoid because it allows the conjunctiva to remain undisturbed. This technique positions the lashes away from the lid margin and further away from the globe.
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Consultations

  • In cases of Stevens-Johnson syndrome or ocular cicatricial pemphigoid, a general medical consult may be necessary.
  • Cornea/external disease and/or oculoplastic services may be required in severe cases.
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Contributor Information and Disclosures
Author

Robert H Graham, MD  Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society

Disclosure: WebMD/eMedicine Salary Employment

Specialty Editor Board

Jorge G Camara, MD  Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Ron W Pelton, MD, PhD, to the development and writing of this article.

References

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Trachoma of upper lid. The trachomatous right upper lid was difficult to evert.
Epiblepharon in an Asian child.
Lower lid trichiasis, Ellman radiofrequency follicle ablation.
Lower lid trachoma with cicatrix.
Ocular cicatricial pemphigoid, symblepharon formation.
Bilateral involutional entropion. Note the periocular redness from constant lid rubbing due to irritation.
Entropion (close up). Note that the lashes of the lower lid are not easily visible because they are turned in under the lower lid. The pen markings are for lower lid retractor reinsertion and orbicularis debulking. The patient also will have a lateral tarsal strip.
Snap back test. Retraction of the skin of the lower lid on the right.
Snap back test. The lid does not reapproximate the globe after the retraction is released.
Postoperative lid retraction with lower lid tissue stuck down to hardware on the orbital rim after a transconjunctival approach to a rim and floor fracture on the left eye. The lashes are now turned toward the eye. The patient also has a phthisical right eye.
 
 
 
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