Trichiasis is a common yet treatable ocular condition in which the eyelashes grow inward towards the eye, rather than outward as is typical. This can lead to irritation, redness, and potential damage to the cornea.¹ If left untreated, more serious complications can develop, including chronic discomfort, infections, or even vision impairment.² Fortunately, there are multiple highly effective treatment options, both surgical and non-surgical, that can effectively address the condition and prevent complications. 

The prognosis of trichiasis after treatment is generally positive.¹ Treatment for trichiasis varies based on severity and recurrence. Initially, a specialist may manually remove the affected eyelashes or prescribe lubricating eye drops to relieve discomfort.³ However, given lashes typically regrow within 4-6 weeks, symptoms can persist. For long-term relief, advanced treatments like electrolysis, cryoablation, or laser therapy can target and eliminate the affected hair follicles to reduce the likelihood of recurrence.^1,2,4 In severe or chronic cases, surgical interventions may be necessary to correct the underlying issues. These treatments are highly effective, though they may come with some risks or side effects, such as temporary inflammation or scarring. However, with proper medical care and follow-up, the long-term prognosis for individuals with trichiasis is positive. 

Continue reading to learn more about trichiasis itself, including its causes and symptoms, as well as the benefits, effectiveness, and potential risks of different treatment options, along with recommendations for long-term management and optimal eye health. 

Pathophysiology of trichiasis 

Trichiasis is an acquired condition that can develop over time, in which the eyelashes deviate, growing inwards towards the eyeball instead of outward.¹ The misdirection of eyelashes can irritate the inner surface of the eyelids, cornea and conjunctiva.² Usually, it is the central area of the lower eyelashes that is affected.³ Misdirection of the upper eyelashes is often associated with more serious complications, such as trachoma. Trichiasis affecting eyelashes in the corner of the eye is called canthal trichiasis.³ 

Trichiasis can affect anybody; however, the condition occurs most commonly amongst adults.¹ The condition typically causes irritation, and if left untreated, can cause subsequent ocular morbidities.¹ 

Symptoms 

Common symptoms of trichiasis include:^3,4,5

• Eye irritation 
• Eye redness 
• The sensation that there is something in your eye (foreign body sensation)
• Eye tearing or watering 

Other symptoms include:^3,4,5

• Eye Abrasion 
• Sensitivity to light (Photophobia) 
• Ulcer(s) 
• Decreased vision 

Causes and risk factors 

The main causes of trichiasis include chronic inflammation of the eye, trauma/injury to the eye, or skin and conjunctival disease and infection.^1,4

Certain conditions may increase your risk of developing trichiasis.⁶ Commonly associated diseases and infections include: 

• Distichiasis 
• Epiblepharon
• Blepharitis
• Trachoma 
• Shingles
• Autoimmune Disorders 
• Psoriasis 

Diagnosis

Diagnosing trichiasis is relatively straightforward. An eye care specialist can perform an eye exam and identify the presence and number of affected eyelashes.³ The severity of the diagnosis is usually determined by the extent of eyelid involvement.¹ Questions about medical history can be used to determine if there are any underlying or accompanying conditions.¹ If there is an underlying aetiology, alternative treatments may be recommended. 

Treatment and management

The primary aim of treatment is to protect the cornea, which is achieved by removal or correction of the route of the misdirected “cilia” (eyelashes). Often, the first step involves applying lubricating eye drops to alleviate the irritation caused by trichiasis.⁶ Initially, an eye care specialist may simply remove the affected eyelashes.⁴ However, eyelashes regrow every 4-6 weeks, meaning there is a chance of recurrence. In this instance, or if there are many eyelashes affected, then a more advanced treatment plan will be recommended. 

Electrolysis and radiosurgery 

Electrolysis is a common treatment method for trichiasis.¹ It is often used alongside radiosurgery and uses heat energy to permanently destroy the affected eyelash follicles.³ Multiple treatment sessions can be necessary to ensure complete destruction of the affected follicles.⁴ People can usually return home the same day as the surgery. However, they may experience some swelling and bruising, although these effects should disappear entirely within 3-4 weeks.⁴ For minor cases of trichiasis, this is a very effective treatment. For more severe cases, it can be associated with high recurrence rates and cause scarring.¹

Cryosurgery 

With a high number of affected eyelashes, cryosurgery is a common recommendation.⁴ This involves removing the hair follicles by freezing them.³ After the first session, success rates range from 34-56%, increasing to 70-90% after the second session.¹ It is important to note that normal eyelashes may be destroyed in the treated area.⁴ There is also a risk of eyelid depigmentation and scarring.^1,3

To increase the success rate, cryosurgery may be paired with eyelid malposition surgery or eyelid splitting.^3,4 The latter involves an eye care specialist making a small incision on the eyelid to expose the affected follicles, and then using cryosurgery on the affected eyelashes.³

Laser ablation 

Laser ablation may be recommended to treat triachis, and typically results in less inflammation and fewer complications than other treatment options.¹ However, it is usually only successful in minor cases of trichinosis.³

Other treatment options 

• Intermarginal split lamella with graft¹
• Releasing follicle roots³
• Radiofrequency ablation 

Recovery 

Recovering from surgery should not take more than a couple of days.³ A dressing may be placed over the affected area to protect against bruising from the anaesthetic injection. Some swelling and bruising is normal; however, using cold compresses can help to limit discomfort.⁴ Individuals may return to work immediately, or whenever they feel comfortable.⁴ However, if their job involves physical or intense activity, they may prefer to wait for the swelling and bruising to subside.¹ Some individuals may experience temporary sensitivity to light or slightly blurred vision for a few days.⁴

Prognosis after treatment

The long-term prognosis for people with trichiasis is generally positive, especially with early and appropriate treatment. The success of treatment depends on several factors, including the severity of the condition, the chosen intervention, and whether there are any underlying ocular conditions contributing to the deviated eyelashes. 

Temporary methods, such as manual eyelash removal, offer quick relief; however, they often require repeated treatments and are insufficient for more serious cases. The more advanced treatment options discussed, including electrolysis, radiosurgery, cryosurgery, and laser ablation, offer a higher chance of permanent resolution. It is important to discuss the potential side effects with an eye care specialist to determine the most effective and appropriate option. 

Preventing recurrence 

Whilst it is not always possible to prevent recurrence, as it is impossible to control the way eyelashes grow, there are ways to promote good eye health.³ Prescription lubricating eye drops and good basic eye hygiene can help to promote good eye health and prevent complications. 

FAQ’s

Can I remove the affected eyelashes myself? 

You should not attempt to remove the affected eyelashes yourself, as this may cause damage to the cornea.⁷ If you experience any of the symptoms mentioned, consult an eye specialist for proper care. 

Is trichiasis contagious?

Trichiasis is not contagious in itself. However, the associated infections, such as trachoma, can be. It is important to take care and seek medical advice to understand your condition. 

Can trichiasis make me blind? 

Trichiasis itself does not cause permanent loss of vision. However, repeated and/or untreated infections can result in the development of trachoma. Trachoma is a serious public health concern and one of the leading causes of blindness worldwide. Therefore, seeking timely care at the onset of symptoms is crucial to prevent complications.

Summary

On the whole, the long-term prognosis for trichiasis is highly favourable, especially with early diagnosis and appropriate treatment. While temporary solutions can provide initial relief, advanced procedures offer more lasting results by addressing the root hair follicle of the misdirected eyelashes. Although recurrence is possible, proper follow-up care, good eye hygiene, and regular monitoring can help to manage symptoms effectively. Understanding the condition, recognising warning signs early, and consulting an eye care specialist will help to prevent any lasting complications and ensure optimal eye care. With punctual care and the correct treatment, individuals with trichiasis can achieve lasting comfort and protection for their vision.