Trichiasis is an acquired misdirection of eyelashes (Fig 12-10). The treatment method is usually determined by the pattern (segmental or diffuse) of the misdirected lashes and the quality of the posterior lamella of the involved eyelid. Inturned lashes not associated with involutional entropion are usually seen in cases of chronic eyelid inflammation and posterior lamellar scarring (marginal cicatricial entropion). If the eyelid margin is misdirected, treatment should focus on correcting the entropion.
Trichiasis may be initially treated with mechanical epilation. Because of eyelash regrowth, recurrence can be expected 3–8 weeks after epilation. Broken cilia are often more irritating to the cornea than mature longer lashes.
Figure 12-10 Trichiasis of the right upper eyelid.
(Courtesy of Bobby S. Korn, MD, PhD.)
Standard electrolysis or radiofrequency ablation is used for definitive treatment of trichiasis. The energy is delivered through an insulated needle to destroy the hair follicle. When the needle tip is removed, the lash is easily extracted. However, the recurrence rate is high, adjacent normal lashes may be damaged, and scarring of the adjacent eyelid margin tissue can worsen the problem.
Segmental trichiasis can be treated with cryotherapy in an office procedure that requires only local infiltrative anesthesia. The involved area is frozen for approximately 25 seconds, allowed to thaw, and then refrozen for 20 seconds (double freeze–thaw technique). The lashes are mechanically removed with forceps after treatment. Edema lasting several days, loss of skin pigmentation, notching of the eyelid margin, and possible interference with goblet cell function are disadvantages of cryotherapy.
Argon laser treatment of trichiasis can be useful when only a few scattered eyelashes require ablation or when the stimulation of larger areas of inflammation is undesirable. Some pigment is required in the base of the lash to absorb the laser energy and ablate the lash, making this technique sensitive to hair color.
In all of these procedures, success rates vary, and additional treatment sessions are commonly necessary. An ophthalmic microtrephine can also be used to extract misdirected eyelash units. Full-thickness pentagonal resection with primary closure may be considered when trichiasis is confined to a segment of the eyelid.
Dutton JJ, Tawfik HA, DeBacker CM, Lipham WJ. Direct internal eyelash bulb extirpation for trichiasis. Ophthalmic Plast Reconstr Surg. 2000;16(2):142–145.
McCracken MS, Kikkawa DO, Vasani SN. Treatment of trichiasis and distichiasis by eyelash trephination. Ophthalmic Plast Reconstr Surg. 2006;22(5):349–351.
Rosner M, Bourla N, Rosen N. Eyelid splitting and extirpation of hair follicles using a radiosurgical technique for treatment of trichiasis. Ophthalmic Surg Lasers Imaging. 2004;35(2):116–122.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.