Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Trichiasis Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 15, 2016
 

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]

Li et al have found that doxycycline has successfully suppressed the contractile fibroblasts in patients with trachoma and suggest that doxycycline might be useful as a treatment to prevent recurrence of trichiasis following surgery.[5]

Next

Surgical Care

Surgery for trichiasis can substantially improve quality of life, regardless of changes in visual acuity, as shown by Habtamu et al.[6] 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

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.[7, 8]

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 follic Lower lid trichiasis, Ellman radiofrequency follicle ablation.

Mitomycin C injected into the hair follicle immediately after radiofrequency ablation may reduce recurrence of trichiasis.[9]

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.[10]

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

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.

Posterior lamellar tarsal rotation was found to be superior to bilamellar tarsal rotation in managing trachomatous trichiasis.[11] Barr et al reported that anterior lamellar repositioning for trachomatous trichiasis yielded results that were similar to those of bilamellar tarsal rotation, although they cautioned that the results are uncertain owing to inconsistent follow-up times.[12]

Previous
Next

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.

Previous
 
 
Contributor Information and Disclosures
Author

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

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

Disclosure: Partner received salary from Medscape/WebMD for employment.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

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

References
  1. Rajak SN, O Collin JR, Burton MJ. Trachomatous Trichiasis and its Management in Endemic Countries. Surv Ophthalmol. 2012 Jan 27. [Medline].

  2. Ngondi J, Reacher MH, Matthews FE, et al. Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan. Trans R Soc Trop Med Hyg. 2009 Mar. 103(3):305-14. [Medline].

  3. Ngondi J, Gebre T, Shargie EB, et al. Risk factors for active trachoma in children and trichiasis in adults: a household survey in Amhara Regional State, Ethiopia. Trans R Soc Trop Med Hyg. 2008 May. 102(5):432-8. [Medline].

  4. West ES, Munoz B, Imeru A, Alemayehu W, Melese M, West SK. The association between epilation and corneal opacity among eyes with trachomatous trichiasis. Br J Ophthalmol. 2006 Feb. 90(2):171-4. [Medline].

  5. Li H, Ezra DG, Burton MJ, Bailly M. Doxycycline prevents matrix remodeling and contraction by trichiasis-derived conjunctival fibroblasts. Invest Ophthalmol Vis Sci. 2013 Jul 12. 54(7):4675-82. [Medline]. [Full Text].

  6. Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Mohammed A, et al. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia. PLoS Negl Trop Dis. 2016 Apr. 10 (4):e0004627. [Medline].

  7. Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, Genet A, et al. Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial. PLoS Med. 2011 Dec. 8(12):e1001136. [Medline]. [Full Text].

  8. Rajak SN, Habtamu E, Weiss HA, Bedri A, Gebre T, Genet A, et al. Epilation for trachomatous trichiasis and the risk of corneal opacification. Ophthalmology. 2012 Jan. 119(1):84-9. [Medline].

  9. Kim GN, Yoo WS, Kim SJ, Han YS, Chung IY, Park JM, et al. The effect of 0.02% mitomycin C injection into the hair follicle with radiofrequency ablation in trichiasis patients. Korean J Ophthalmol. 2014 Feb. 28 (1):12-8. [Medline].

  10. Moore J, De Silva SR, O'Hare K, Humphry RC. Ruby laser for the treatment of trichiasis. Lasers Med Sci. 2009 Mar. 24(2):137-9. [Medline].

  11. Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewudie Z, et al. Posterior lamellar versus bilamellar tarsal rotation surgery for trachomatous trichiasis in Ethiopia: a randomised controlled trial. Lancet Glob Health. 2016 Mar. 4 (3):e175-84. [Medline].

  12. Barr K, Essex RW, Liu S, Henderson T. Comparison of trichiasis recurrence after primary bilamellar tarsal rotation or anterior lamellar repositioning surgery performed for trachoma. Clin Experiment Ophthalmol. 2014 May-Jun. 42 (4):311-6. [Medline].

  13. Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-Year Outcomes of the Surgery for Trichiasis, Antibiotics to Prevent Recurrence Trial. Arch Ophthalmol. 2011 Dec 12. [Medline].

  14. Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-Year Outcomes of the Surgery for Trichiasis, Antibiotics to Prevent Recurrence Trial. Arch Ophthalmol. 2012 Feb 14. [Medline].

  15. Bartley GB, Bullock JD, Olsen TG, Lutz PD. An experimental study to compare methods of eyelash ablation. Ophthalmology. 1987 Oct. 94(10):1286-9. [Medline].

  16. Bartley GB, Lowry JC. Argon laser treatment of trichiasis. Am J Ophthalmol. 1992 Jan 15. 113(1):71-4. [Medline].

  17. Burton MJ, Bowman RJ, Faal H, et al. The long-term natural history of trachomatous trichiasis in the Gambia. Invest Ophthalmol Vis Sci. 2006 Mar. 47(3):847-52. [Medline].

  18. Burton MJ, Kinteh F, Jallow O, et al. A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia. Br J Ophthalmol. 2005 Oct. 89(10):1282-8. [Medline].

  19. Chi MJ, Park MS, Nam DH, Moon HS, Baek SH. Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis. Graefes Arch Clin Exp Ophthalmol. 2007 May. 245(5):637-40. [Medline].

  20. Collin RJO. Entropion and trichiasis. A Manual of Systemic Eyelid Surgery. New York: Churchill-Livingstone; 1989. 7-26.

  21. Dhaliwal U, Nagpal G, Bhatia MS. Health-related quality of life in patients with trachomatous trichiasis or entropion. Ophthalmic Epidemiol. 2006 Feb. 13(1):59-66. [Medline].

  22. Durkin SR, Casson R, Newland HS, Selva D. Prevalence of trachoma and diabetes-related eye disease among a cohort of adult Aboriginal patients screened over the period 1999-2004 in remote South Australia. Clin Experiment Ophthalmol. 2006 May-Jun. 34(4):329-34. [Medline].

  23. Edwards T, Cumberland P, Hailu G, Todd J. Impact of health education on active trachoma in hyperendemic rural communities in Ethiopia. Ophthalmology. 2006 Apr. 113(4):548-55. [Medline].

  24. El Toukhy E, Lewallen S, Courtright P. Routine bilamellar tarsal rotation surgery for trachomatous trichiasis: short-term outcome and factors associated with surgical failure. Ophthal Plast Reconstr Surg. 2006 Mar-Apr. 22(2):109-12. [Medline].

  25. Elder MJ, Collin R. Anterior lamellar repositioning and grey line split for upper lid entropion in ocular cicatricial pemphigoid. Eye. 1996. 10 (Pt 4):439-42. [Medline].

  26. Johnson RL, Collin JR. Treatment of trichiasis with a lid cryoprobe. Br J Ophthalmol. 1985 Apr. 69(4):267-70. [Medline].

  27. Jordan DR, Zafar A, Brownstein S, Faraji H. Cicatricial conjunctival inflammation with trichiasis as the presenting feature of Wegener granulomatosis. Ophthal Plast Reconstr Surg. 2006 Jan-Feb. 22(1):69-71. [Medline].

  28. Kersten RC, Kleiner FP, Kulwin DR. Tarsotomy for the treatment of cicatricial entropion with trichiasis. Arch Ophthalmol. 1992 May. 110(5):714-7. [Medline].

  29. Kuckelkorn R, Schrage N, Becker J, Reim M. Tarsoconjunctival advancement: a modified surgical technique to correct cicatricial entropion and metaplasia of the marginal tarsus. Ophthalmic Surg Lasers. 1997 Feb. 28(2):156-61. [Medline].

  30. Nagpal G, Dhaliwal U, Bhatia MS. Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital. Ophthalmic Epidemiol. 2006 Feb. 13(1):53-8. [Medline].

  31. Polack S, Brooker S, Kuper H, Mariotti S, Mabey D, Foster A. Mapping the global distribution of trachoma. Bull World Health Organ. 2005 Dec. 83(12):913-9. [Medline].

  32. Rhatigan MC, Ashworth JL, Goodall K, Leatherbarrow B. Correction of blepharoconjunctivitis-related upper eyelid entropion using the anterior lamellar reposition technique. Eye. 1997. 11 (Pt 1):118-20. [Medline].

  33. Shiu M, McNab AA. Cicatricial entropion and trichiasis in an urban Australian population. Clin Experiment Ophthalmol. 2005 Dec. 33(6):582-5. [Medline].

  34. Tirakunwichcha S, Tinnangwattana U, Hiranwiwatkul P, Rohitopakarn S. Folliculectomy: management in segmental trichiasis and distichiasis. J Med Assoc Thai. 2006 Jan. 89(1):90-3. [Medline].

  35. West ES, Alemayehu W, Munoz B, Melese M, Imeru A, West SK. Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology. Ophthalmic Epidemiol. 2005 Aug. 12(4):279-86. [Medline].

  36. West S, Alemayehu W, Munoz B, Gower EW. Azithromycin prevents recurrence of severe trichiasis following trichiasis surgery: STAR trial. Ophthalmic Epidemiol. 2007 Sep-Oct. 14(5):273-7. [Medline].

  37. West SK, West ES, Alemayehu W, et al. Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia. Arch Ophthalmol. 2006 Mar. 124(3):309-14. [Medline].

  38. Wojono TH. Lid splitting with lash resection for cicatricial entropion. Ophthalmic Plast Reconst Surg. 1992. 8:287-289.

  39. Wood JR, Anderson RL. Complications of cryosurgery. Arch Ophthalmol. 1981 Mar. 99(3):460-3. [Medline].

  40. Yeung YM, Hon CY, Ho CK. A simple surgical treatment for upper lid trichiasis. Ophthalmic Surg Lasers. 1997 Jan. 28(1):74-6. [Medline].

  41. Zhang H, Kandel RP, Atakari HK, Dean D. Impact of oral azithromycin on recurrence of trachomatous trichiasis in Nepal over 1 year. Br J Ophthalmol. 2006 Aug. 90(8):943-8. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.