Trichiasis - Causes, Symptoms, and Management

Introduction

Trichiasis is an acquired condition of the eyelashes that is characterized by abnormal misalignment of the eyelashes. Normally the lashes face outward. However, in trichiasis, the lashes face the ocular surface instead of the global surface of the eye. It results in severe ocular morbidity as there is constant rubbing of the eyelashes to the ocular surface.

What Is the Normal Anatomy of the Eyelashes?

Eyelashes are a single layer of hair follicles present at the edge of both the upper and lower eyelids. Natural eyelashes start developing by the twenty-second week of pregnancy.

Can Eyelashes Grow Again?

Normally, eyelashes take approximately eight weeks to grow. However, repeated pulling out of the eyelashes may result in permanent damage. The human eyelashes are in a continuous cycle of growth, degradation, and shedding.

What Are the Functions of the Eyelashes?

Eyelashes are the essential barrier that helps prevent the internal surface of the eyes from external environmental factors. They protect the eyes from:

• Dust.

• Foreign particles.

• They are highly sensitive to tactile sensation, hence immediately warning the eye about the nearby object.

• They also play a vital role in enhancing the beauty of the face.

Is Trichiasis of the Eyelashes Common?

Trichiasis remains a global burden, with more than 2.5 million people globally suffering from the condition. The incidence of trichiasis increases with age. It is frequently associated with trachoma (infection of the eye caused by Chlamydia trachomatis).

What Are the Causes of Trichiasis?

Trichiasis most commonly occurs secondary to an inflammatory and infectious condition of the eye.

The following are the causes of trichiasis:

• Eyelid margin inflammation.

• Dermal conditions like herpes zoster, eczema, etc.

• Diseases of the conjunctiva such as Steven-Johnson syndrome, ocular pemphigoid, and vernal keratoconjunctivitis.

• Burns. Burns include both electrical and chemical burns.

• Eyelid scars due to surgery or trauma.

• Eye infections.

• Autoimmune disorders.

What Are the Clinical Signs and Symptoms Seen in Patients Suffering From Trichiasis?

Majority of cases of trichiasis show bilateral eye involvement. The clinical presentation of patients suffering from trichiasis includes:

• There is a persistent feeling of irritation in the eyes.

• Sensitivity to light.

• Redness of the eyes.

• Tears.

• Dry eyes.

• Burning sensation.

• Pain.

• Congestion in the conjunctiva.

• Vertically positioned eyelashes.

What Are the Different Types of Trichiasis?

Trichiasis is of different types depending upon the amount of malaligned hair follicles or cilia involved and the portion of the eyelid involvement.

Based on the Amount of Hair, Trichiasis Is of Two Types

• Minor, in this, less than five cilias are involved.

• Major, more than five hair involvement.

Based on the Extension of the Eyelid, It Is of Two Types

• Segmental.

• Diffuse.

How Is a Patient With Trichiasis Evaluated?

The diagnosis of trichiasis does not pose much of a challenge. However, it is essential to determine the root cause of the condition.

• A careful physical examination of the condition is done to determine the malalignment of the eyelashes. Fornix and lamellar scars, symblepharon formation, etc., are noted with the help of the slit-lamp technique.

• Conjunctiva is checked thoroughly to look out for adhesion of the conjunctiva with adjacent cornea or conjunctiva.

• If the patient reports a recent eyelash removal, the examination is repeated after two to three weeks.

Can Any Other Disease Have a Similar Presentation as Trichiasis?

Trichiasis of the eyelashes is often confused with other conditions with similar presentations. The main conditions with similar conditions include:

• Entropion.

• Distichiasis.

Distichiasis is the presence of another row of eyelashes or cilia. It is a congenital anomaly presenting within five years, while entropion is the inward orientation of the eyelid margin. Other conditions comprise:

• Steven-Johnson syndrome.

• Red eye.

• Trachoma.

What Are the Different Treatment Modalities for Trichiasis?

The main purpose behind the treatment of trichiasis is to improve patients' comfort and esthetic concern. In case the condition is caused by another underlying disease, then treating the condition is essential. Trichiasis can be treated both medically and surgically. Non-surgical measures provide short-term results, whereas surgical management gives effective long-term treatment. However, surgical treatment is not possible in patients with acute inflammatory conditions who often have a high recurrence rate.

• Non-surgical Treatment Options for Trichiasis Include:

  • If only a few eyelashes are affected, the affected lashes are removed with a tweezer.

  • Use of contact lenses.

  • Mechanical Ablation.

  • Lubricants and artificial tears help in reducing the irritating effect.

  • When trichiasis is accompanied by trachoma infection, a single dose of Azithromycin injection is enough to reduce the recurrence rate.

• Surgical Treatment Options for Trichiasis Include:

  • Surgical treatment options for trichiasis include.

  • Laser ablation is used in treating minor problems.

  • Cryosurgery. The hair follicles are cut by freezing them.

  • Electrolysis. It permanently removes the hair. However, it is time-consuming and painful.

  • Radiofrequency ablation is the most effective treatment option with lesser complications. It uses low radiation to selectively destroy the affected lashes.

  • Surgical excision is recommended for diffuse trichiasis patients, scarring, and relapsing cases.

A few excision techniques performed are:

• Repositioning of the anterior lamella.

• Partial excision of the lamella.

• Full thickness resection.

• Eyelash bulb resection.

• Rotation of the tarsal.

Can Trichiasis Cause Severe Damage to the Eye?

Trichiasis, if left untreated, is associated with conditions that threaten the vision like -

• Corneal scarring.

• Microbial keratitis.

• Corneal abrasion.

• In extreme cases, it can cause blindness.

What Is the Prognosis of Trichiasis?

Overall, trichiasis has an excellent prognosis after treatment. Regular follow-up helps prevent complications and recurrence. Patients are to be educated about the signs of misaligned and newer growth of eyelashes. They are to be made aware of the recurring capacity of the condition and are advised to seek immediate treatment.

Conclusion

Trichiasis is a global burden that is highly distressing and severely affects the quality of life in patients suffering from it. It can be caused by multiple factors and most commonly occurs with trachoma. Trichiasis enjoys a very good prognosis, with a resolution of the condition taking place after treatment. However, long-term follow-up is crucial to prevent complications.