Trichiasis

Eyelashes on the lid were misdirected inwards to the eye in trichiasis condition, leading to ocular morbidity. People may feel something in their eye or eyelash touching the cornea, frequent tearing, pain, and light sensitivity.¹ The lashes cause attrition to the cornea, conjunctiva, and the inner surface of eyelids, causing eye irritation.

Other conditions caused by eyelashes

Entropion

This is a different condition,  such as folding of the eyelid inwards and rubbing against the eyeball.²

Distichiasis

There will be an extra row of eyelashes grown behind the normal row of eyelashes.³

Tristichia/tetrastichiasis

A rare condition where the third (Tristichia) or fourth row (Tetrastichiasis) of eyelashes is present.⁴

Pseudocilium  

The loose eyelash enters the punctum or meibomian gland, which may cause watering of the eye, also in some cases irritation to the cornea and conjunctiva.⁵

Alopecia adnata

Underdeveloped, broken lashes or Loss of eyelashes (Madarosis) may be isolated. The major cause might be eyelid trauma, eyelid inflammation, etc.⁶

Hypertrichosis

Abnormal hair growth of any part of the body, including eyelashes⁷

Trichomegaly

A condition where the eyelash and eyebrow grow in an abnormal length.⁷

Cilia Incarnata

The misdirected growth of lashes under the skin rather than emerging from the eyelid margin.⁸

Eyelash ptosis

Sagging of the upper eyelashes obstructs eye view. It might be related to floppy eyelid syndrome.⁹

Ectopic or accessory cilia

A rare condition where lashes will grow in abnormal locations of the eyelid, which can cause conjunctivitis.¹⁰

Dry eye syndrome or disease

Dry eye syndrome or disease (DES/D) is also termed keratoconjunctivitis sicca (KCS), is a polygenic disease that causes discomfort to the ocular surface specifically because of reduced lubrication by the tears. There are 2 reasons for the dry eye, one is due to decreased secretion of the tear, and increased tear evaporation. This may be due to tear film hyperosmolarity and lachrymal and ocular inflammation, or systemic drugs like antihistamines, decongestants, diuretics, beta-blockers, etc. The possible cause is related to autoimmune or systemic conditions.

Meibomian glands

These are present in the eyelid margin, secreting oil which protects the tear film by forming a lipid layer around them, leading to a reduction of tear evaporation.¹¹

Trichiasis and dry eye syndrome relationship

Trichiasis causes dry red eye due to damage to the surface of the cornea, leading to abrasion and irritation by reducing eye lubrication.¹²

It causes discomfort in the eye, disturbs vision, unstable tear film, ocular inflammation, and high osmolarity of the tear.¹³

Causes and risk factors¹⁴

Trachoma

The history of follicular inflammation, which is also associated with Herbert’s pits.

Autoimmune disorders (Stevens-Johnson syndrome)

These are caused by the reaction to new medications. May lead to defects in the cornea and conjunctiva.

Blepharokeratoconjunctivitis

Chronic inflammation of the eyelid margin.

Keratitis

Inflammation of the cornea causes red eye, pain, tearing, and photophobia.

Chemical injury

Accidental or unknown installation of chemicals into the eyes can cause scarring of the cornea, keratitis, and trichiasis.

Ocular trauma

Wound and scar to the cornea cause trauma to the iris, lens, and cataract.

Ageing

It can lead to weakening of eyelid structure, reduction in blinking rate, and other conditions like diabetes affecting the tear production.

Ocular surface diseases

Chronic disease of the eye, which causes poor quality and quantity of tears. They experience eye itching, redness, dryness, and irritated eyes.

Environmental factors

Dry air and smoke can increase the risk.

Diet

Low vitamin A and omega-3 intake can affect eye health.

Evaluation or diagnosis¹⁵

Trichiasis can cause chronic inflammation of the eyelid and its structure, causing tarsal conjunctivitis, corneal opacity, misdirected lashes, etc.

Position of the lashes

By observing the rotation of the eyelid inwards, the sagging of the eye margin.

Tarsal conjunctiva

The upper eyelid should be observed for tarsal inflammation. The major cause is infection, irritation, or immune response.

Opacification of the cornea

The trauma response to the cornea will cause opacification due to infection.

Risk factors of dry eye¹⁶

Systemic conditions

• Diabetes
• Hereditary diseases
• Gut dysbiosis 
• Multiple sclerosis 
• Nerve damage pathologies 

Environmental factors

• Chemical fumes
• Cigarette smoke
• Strong winds
• High temperature
• Pollution
• High altitude
• Low humidity 

Behavioural habits

• Smoking 
• Alcohol 
• Poor sleep 
• Unhealthy diet
• Dislipidemia 

Treatments

Lubrication, Tear drops, Diet, and anti-inflammatory drugs are used to treat the symptoms, and based on the severity, other procedures can be used.¹⁶

The main purpose is to improve patient comfort by removing the extra cilia or lashes. Eyelashes can be removed with a simple method by using forceps. Which is an uncomplicated method. But the recurrence rate is high in this case, the hair may grow within 2-6 weeks.

Surgical treatment

It may show success initially, but there is a high rate of infection and reoccurrence. Specifically, the infection rate is high in patients with.Chlamydia trachomatis.

Other treatments are

Bipolar electrolysis

This electric current application method is effective to treat minor trichiasis; if used for the removal of multiple lashes, it may damage the lid. Also, this method has a high recurrence rate.

Radiofrequency ablation

This method is also similar to bipolar electrolysis with minimal complications. It causes less damage and has a better success rate. These involve radiofrequency waves, which are particularly used to destroy follicles.

Cryotherapy

It is a very effective treatment to diffuse trichiasis compared to previous treatments. As they are very sensitive to freezing (-20°C to -30°C), which effectively destroys the hair follicles but has less effect to the surrounding skin and tissues. It has a better success rate with two applications. But the risks include recurrence, dry eye syndrome, necrosis, inflammation, corneal ulcer etc.

Laser ablation

It has better treatment and is safer for minor trichiasis than cryotherapy and electrolysis methods. For multiple lashes, it's better to go with the surgical option. Lasers like Argon, Carbon dioxide, and Ruby are showing success rates in one session from 37% to 59%, and with multiple sessions, about 100% were reported.¹

Lid surgery

This procedure can be used to prevent trachoma-induced blindness. Tarsal rotation, where the lid margin will be rotated to prevent abrasion to the cornea. Other methods like lamellar lengthening, lamellar repositioning, Eversion splinting, Tarsal grooving and tarsectomy.

Surgical complications

The selection of suitable surgery for the patient is difficult considering the factors, recurrence rate, and other drawbacks, including after surgery complications like suture infection (suture material and number of sutures), comorbid diseases, short or scarred lamella, stitch granuloma, conjunctival infection, age, sex, and regular conjunctival conditions.¹⁵

Summary

Trichiasis is a disease related to dry eye syndrome, which is an ocular disease; if it’s not treated can cause chronic inflammation, corneal damage, opaque eye, leading to vision impairment. This condition may arise due to a previous eye condition history, with trachoma is an inflammatory condition which is associated with dry eye due to mechanical irritation. It may also be because of increased evaporation of tears and damage to the surface of the cornea. Early diagnosis is very important to avoid visual impairment and for easy management of the condition. Eye care with regular examination and checkups with a physician for underlying disease will be beneficial to identify and prevent further development of the condition and to maintain eye health and function.

FAQs

What is trichiasis?

Trichiasis is an eye disease where the eyelashes on the lid are misdirected inwards to the eye, irritating the cornea.

What causes trichiasis?

This condition is commonly seen in patients who have suffered from chronic inflammation, autoimmune diseases, eye trauma, scarring of eye eyelid, and eyelid changes due to aging.

How is trichiasis related to dry eye syndrome?

Inwardly rotated lashes will scar the cornea, leading to disruption of the tear film, increased evaporation of tears, or decreased secretion of tears, causing dry eye syndrome, showing irritation, redness, and blurry vision.

What are the common symptoms of trichiasis-related dry eye?

Feeling of something stuck in the eye, increased tears, red eye, irritation, vision impairment, and light sensitivity.

Can trichiasis cause permanent vision loss?

If it’s not treated the earliest, it can lead to vision impairment.

How can trichinosis be prevented?

Being aware of the eye, trying to prevent infections, maintaining eye hygiene, and using only sterile products for the eye, early treatment for eye diseases can reduce the occurrence of trichiasis.