Introduction

The eyes are one of the most sensitive organs in the body and can therefore be affected by a range of medical conditions, resulting in many uncomfortable and potentially life-threatening outcomes. One particular symptom that can be very unpleasant and damaging to human sight is the phenomenon of eyelashes growing inwards, towards the eyeball, instead of the usual outward way. This condition is called trichiasis, and while it might sound like just a minor irritation, it can actually lead to serious discomfort, eye damage, and vision problems if left untreated. Certain autoimmune conditions are linked with trichiasis and other eye disorders. In these cases, the eyelash problem may be one of several signs of a broader health issue, and it must be explored thoroughly in order to ensure the best treatment options possible and reduce the risk of long-term damage to those who suffer.

Trichiasis

Trichiasis is a medical condition that consists of eyelashes growing on the inside of the eye, resulting in irritation and damage to the eyeballs due to the rubbing of the lashes against the cornea of the eye. It is a relatively rare condition that can result in major damage to the eye, and if left untreated, can cause sight-threatening conditions such as keratitis, corneal abrasion and scarring.¹ The diagnosis is that of a clinical examination of the eyes and the person as a whole. Typically, the person may complain of pain, stinging and watering of the eyes, often associated with redness and a reduction in vision commonly described as a ‘glare’.²

The condition can occur at any age and in any gender, but is more commonly associated with trauma, congenital defects, ocular infections and scarring from any past conditions or surgeries.³ In some cases, certain autoimmune conditions specifically associated with ocular manifestations can result in trichiasis development, which requires very careful and planned treatments, often targeting the autoimmune dysfunction of the body first.

The mainstay of treatment for trichiasis is surgical removal or adaptation of the ingrowing eyelashes. This is often accompanied by different types of laser therapy that help to remove the eyelash follicles.⁴ In some countries, trials of cryotherapy have occurred to freeze off the inward-growing lashes and have resulted in some successes.⁵

Autoimmune Conditions

In autoimmune disease, the body develops antibodies against itself, resulting in damage and improper functioning.⁶ The normal immune cells that protect the body against harmful stimuli are T and B cells. In autoimmune disease, these T and B cells overfunction and react to their own body parts, ultimately resulting in tissue destruction and organ dysfunction. This is the main mechanism in which many of the common autoimmune conditions occur.⁷

Currently, around 3-5% of the population is affected by autoimmune conditions, and within this group, there are some more commonly identified conditions. Type 1 diabetes, coeliac disease, multiple sclerosis, rheumatoid arthritis and SLE are some of the more common autoimmune conditions that affect many people across the globe.⁷ These conditions have some similar presentations; however, not all involve changes to the eyes. 

Rheumatoid arthritis is one of the autoimmune conditions that has associations with eye disease in some cases, but typically presents with joint pains and limited movements and can affect the eyes at much more advanced stages.⁸

Autoimmune Trichiasis 

Manifestations of eye disease associated with autoimmune conditions can occur during active phases of disease and also in periods of long-term remission. If someone has one autoimmune condition, they are at an increased risk of developing further autoimmune conditions. If this occurs and multiple autoimmune conditions are present, there is an increased risk of developing trichiasis.⁹ Other eye conditions can also be present that have similar symptoms to trichiasis; These include episcleritis, scleritis and dry eye disease.

As autoimmune conditions are associated with increased levels of inflammation throughout the body, those that can affect the eyes as well as other areas in the body can cause chronic low-level inflammation to the eyelids. Over time, chronic inflammation in these areas can cause scarring to the lids, one of the main causes of increasing the risk of trichiasis.¹⁰

Even though trichiasis’ association with autoimmune conditions isn’t very commonly explored, there is some evidence of its presence in a number of these autoimmune conditions. This needs to be further explored in future research. 

Summary

Trichiasis is a relatively rare condition where eyelashes grow inward and rub against the eye, causing irritation and possible damage. While it can happen after infections or injuries, it is sometimes linked to autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues.

Autoimmune conditions such as rheumatoid arthritis, Stevens–Johnson syndrome, and lupus can cause inflammation and scarring of the eyelids, leading to misdirected lash growth. Recognising these autoimmune links is important, since treating the underlying immune problem can help prevent eye damage and protect vision. Further research is needed to help identify those at risk of developing this inflammation and scarring in the future, to prevent further pain for those affected with autoimmune conditions.