Trichiasis

Trichiasis is an abnormal growth of the eyelashes on the anterior plate of the eyelid, accompanied by irritation of the cornea and conjunctiva, and secondary infection.

Soft contact lenses can be used to protect the cornea. After regular epilation, eyelashes grow back to their full size in 10 weeks. In case of limited lesions, electrolysis of hair follicles is used to destroy several incorrectly growing eyelashes, and in case of extensive lesions, plastic surgery of the eyelid margin is performed. The prognosis is favorable, but depends on the etiology of the process. Relapse is possible.

Trichiasis is a fairly common pathology; madarosis is considered a rare anomaly; distichiasis and districhiasis are extremely rare.

Causes trichiasis

Trichiasis and madarosis are almost always secondary after injury or burn, after chronic conjunctivitis or blepharitis, herpes infection (Herpes zoster), trachoma (chronic inflammation).

Post-traumatic or post-inflammatory cicatricial changes in the eyelid margin lead to the absence of eyelashes or displacement of the eyelash hair follicles, stimulating their growth in the wrong direction (trichiasis).

Symptoms trichiasis

Trichiasis: eyelashes are directed inward, contact the eyeball, causing irritation, corneal erosion. Blepharospasm and photophobia are expressed. Frequent blinking and squinting provoke damage to the cornea.

Madarosis: localized or widespread absence of eyelashes along the eyelid margin.

Distichiasis: the eyelashes in the additional row are thin, short, directed in different directions, in contact with the eyeball, with virtually no pigment, so they cannot always be detected upon visual examination or even when examined under a slit lamp at low magnification.

Stages

Trichiasis can be localized or widespread, madarosis can be complete or partial, distichiasis can be unilateral or bilateral.

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Forms

Trichiasis can be congenital or acquired. It can develop as a consequence of blepharitis, or it can be caused by an alkali burn, cicatricial pemphigoid, trachoma, or a tumor. Clinically, it manifests itself as lacrimation, a sensation of a foreign body, and superficial punctate keratitis.

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Diagnostics trichiasis

When collecting anamnesis, it is necessary to take into account family history, the presence of injuries, burns, and chronic inflammation.

Physical examination

• Determination of visual acuity.
• External examination (skin around the eye, condition of the eyelids, conjunctiva, presence and growth of eyelashes).
• Biomicroscopy (condition of the eyelid margins, direction of eyelash growth, contact of eyelashes with the cornea and conjunctiva, condition of the cornea).
• Biomicroscopy of the cornea and conjunctiva using dyes (fluorescein).

Laboratory research

Laboratory tests are not performed.

Instrumental research

Instrumental studies are not performed.

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Differential diagnosis

Trichiasis is differentiated from entropion and distichiasis. Madarosis is differentiated from marginal coloboma of the eyelids. Patients with distichiasis are often treated for chronic conjunctivitis, blepharospasm, and ptosis of the upper eyelid.

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Treatment trichiasis

The goal of trichiasis treatment is to prevent corneal pathology in trichiasis and distichiasis. Cosmetic correction in madarosis.

Indication for hospitalization is surgical treatment.

Non-drug treatment

Epilation of abnormally growing eyelashes is a common but impractical method, since after long-term epilation, which is performed almost monthly, the eyelashes become thinner, lose pigment and are more difficult to treat with other methods.

Diathermocoagulation with a needle electrode along the growth of the eyelash to its bulb is advisable for individual eyelashes. It is not advisable to perform diathermocoagulation of a whole row of eyelashes. Several months after resection of the eyelid margin in distichiasis, diathermocoagulation of individual remaining eyelashes is performed.

Argon laser coagulation from the point where the eyelash emerges onto the skin or mucous membrane in the direction of eyelash growth is possible in the presence of individual eyelashes with abnormal growth. Signal power is 0.6 W, pulse exposure is 0.15 s, spot diameter is 100-300 μm, the number of pulses is from 15 to 40. After the procedure, antiseptic drops and ointment are prescribed for three days at night.

Drug treatment

Drug treatment is carried out only after surgical, laser treatment or diathermocoagulation.

Surgical treatment

Trichiasis: penetrating resection of a local section of the eyelid margin with direct approximation of the edges and careful layer-by-layer suturing. In case of widespread trichiasis, reconstruction of the posterior edge of the eyelid with transplantation of a flap of the patient's lip mucosa is possible.

Madarosis: eyebrow flap transplantation is possible to replace complete madarosis. Distichiasis: the main treatment method is surgical (resection of a section of the intercostal space with a row of additional eyelashes). The wound is sutured with separate 6/0-7/0 catgut sutures.

Further management

Observation in dynamics, since it is possible to perform additional intervention (diathermocoagulation, argon laser coagulation) in the presence of newly grown individual eyelashes.

Prevention

To prevent the development of trichiasis after trauma or burns, during primary surgical treatment of eyelid wounds, the costal margin is carefully sutured; in case of burn pathology of the eyelids, surgical ankyloblepharon is performed.

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Forecast

The prognosis is favorable.

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