Trichiasis

Trichiasis is a wrong growth of eyelashes of the anterior plate of the eyelid, accompanied by irritation of the cornea and conjunctiva, secondary infection.

To protect the cornea, soft contact lenses can be used. After a normal epilation, the eyelashes grow back to full size after 10 weeks. With limited lesions, the electrolysis of hair follicles is used to destroy several improperly growing eyelashes, and with extensive ones, plasticizes the edges of the eyelid. The prognosis is favorable, but depends on the etiology of the process. Recurrence is possible.

Trichiasis - a fairly common pathology, a rare anomaly is considered madarose, extremely rarely register distichiasis and distribution.

Causes of the trichiasis

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

Post-traumatic or post-inflammatory cicatricial changes in the edge of the eyelids lead to the absence of eyelashes or the displacement of the hair bulbs of the eyelashes, stimulating their growth in the wrong direction (trichiasis).

Symptoms of the trichiasis

Trichiasis: eyelashes are directed inwards, contact with the eyeball, causing its irritation, erosion of the cornea. Blepharospasm, photophobia is expressed. Frequent blinking and squinting provokes damage to the cornea.

Madaroz: local or widespread absence of eyelashes along the edge of the eyelid.

Dysthychiasis: the eyelashes in the additional row are thin, short, directed in different directions, they come into contact with the eyeball, practically without pigment, therefore, when viewed visually and even when viewed in the light of the slit lamp at low magnification, they can not always be detected.

Stages

Trichiasis can be local or common, madarosis - complete or partial, distichiasis (distribution) is unilateral and bilateral.

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Forms

Trichiasis is congenital and acquired. It can develop as a consequence of blepharitis, and can be caused by an alkaline burn, cicatricial pemphigoid, trachoma or tumor. Clinically manifested by lacrimation, sensation of foreign body, superficial point keratitis.

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Diagnostics of the trichiasis

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

Physical examination

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

Laboratory research

Laboratory studies do not.

Instrumental research

Instrumental studies do not.

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Differential diagnosis

Trichiasis is differentiated with eyelid twisting and distichiasis. Madaroz differentiate with the marginal coloboma of the eyelids. Patients with dysthiasis are often treated for chronic conjunctivitis, blepharospasm, ptosis of the upper eyelid.

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Treatment of the trichiasis

The goal of treating trichiasis is the prevention of corneal pathology with trichiasis and distichiasis. Cosmetic correction with madarose.

Indication for hospitalization is surgical treatment.

Non-drug treatment

Epilation of improperly growing eyelashes is a common but inappropriate method, since after prolonged epilation, which is performed almost monthly, the eyelashes become thinner, lose pigment and are more difficult to give in to other methods of treatment.

Diathermocoagulation with a needle electrode along the length of the eyelash growth to its bulb is suitable for individual eyelashes. Perform diathermocoagulation of a number of eyelashes is impractical. A few months after the resection of the edge of the eyelid, the diasthemocoagulation of the individual remaining eyelashes is performed with distichiasis.

Argon laser coagulation from the place of exit of the eyelash to the skin or mucous membrane in the direction of growth of the eyelash is possible in the presence of separate eyelashes with incorrect growth. The signal power is 0.6 W, the pulse exposure is 0.15 s, the 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 the night for three days.

Medication

Drug treatment is performed only after surgical, laser treatment or diathermocoagulation.

Surgery

Trichiasis: a through resection of the local portion of the edge of the eyelid with a direct approach of the edges and careful layer-by-layer suturing. With the widespread trichiasis, reconstruction of the posterior edge of the eyelid with a transplantation of the flap of the mucous membrane of the patient's lip is possible.

Madaroz: a flap can be transplanted from the eyebrow to replace full madarosa. Distichiasis: the main method of treatment is surgical (resection of the intercostal space with a number of additional eyelashes). The wound is sutured with separate catgut sutures 6 / 0-7 / 0.

Further management

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

Prevention

To prevent the development of trichiasis after trauma or burn during primary surgical treatment of the wounds of the eyelids, the rib margin is carefully sutured, surgical ankyloblophiron is performed in case of burn pathology of the eyelids.

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Forecast

The forecast is favorable.

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