Trichiasis

Question 1

Aetiology

Answer 1

Inward rotation of the lashes causing them to come into contact with the ocular surface, usually secondary to a number of causes

Congenital - failure of germ epithelial cells to differentiate into meibomian glands

Acquired
- ENTROPION - age-related, cicatricial, spastic, congenital, lid turns in causing lashes to touch globe
- TRACHOMA TRICHIASIS - recurrent infection with Chlamydia trachoma causes inflammation of tarsal conjunctiva and scarring -> leading to entropion, trichiasis. corneal opacification
- ABNORMAL GROWTH OF LASHES secondary to chemical burns, ocular cicatricial pemphigoid, SJS, chronic blepharitis

Question 2

Predisposing factors

Answer 2

Staphylococcal blepharitis
Trachoma
Ocular cicatricial disease

Question 3

Symptoms

Answer 3

Irritation, discomfort, FB sensation, grittiness

Watering
Red eye
Photophobia

Question 4

Signs

Answer 4

Lashes are in contact with the globe
Conjunctival hyperaemia and injection
Epiphora
with NaFl - conjunctival and corneal epithelial defects / disturbance

Some complications may include pannus, corneal ulceration, scarring.

Question 5

Non-pharmacological management

Answer 5

Lid hygiene for associated blepharitis
Removal of offending lashes with forceps - advise of regrowth in 4-6 weeks and may require epilation
If due to entropion, tape lid away from globe to cheek
Therapeutic CL to protect cornea - bandage CL

Question 6

Pharmacological management

Answer 6

Lubricants and ointment
PF as long term treatment

Question 7

Referral and management at HES?

Answer 7

Not usually required in mild cases where they can be managed by epilation of lashes

In more severe cases, refer URGENTLY

At hospital:
- Electrolysis -electric current passed through lash follicle to destroy it
- Cryotherapy - nitrous oxide cryoprobe used to eliminate a large number of lashes, can cause skin depigmentation
- Laser ablation - lasers used to burn the lash follicles and root
- Surgical correction of entropion - tightening of lids by everting sutures and lateral tarsal strip
- If due to trachoma, full thickness tarsotomy and rotation of lash bearing tissue is effective