What Is Trichiasis?

  • Hasanain IftikharDoctor of Pharmacy - PharmD, Pharmaceutical Sciences, Riphah International University
  • Laura HawkinsDoctor of Medicine - MB BCh BAO - Belfast medicine, Queen’s University
  • Ellen Rogers MSc in Advanced Biological Sciences, University of Exeter

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Our eyelashes are designed to protect our eyes from dust and other debris, but they can sometimes cause you to experience irritation or discomfort. You are usually able to relieve this discomfort by blinking repeatedly or rubbing your eyes. However, if the pain doesn’t go away, you could be suffering from a condition called trichiasis. 

Trichiasis is a public health issue in 42 countries but primarily affects rural and underdeveloped areas of Africa, Central and South America, Asia, Australia, and the Middle East. It is estimated that trichiasis affects approximately 2.8 million people every year.1 Luckily, trichiasis can be prevented and treated. Read on to learn more about it and what to do when the issue arises and when to seek timely treatment.

What is trichiasis? 

Trichiasis is a condition in which your eyelashes grow abnormally. Rather than growing outwards as normal, they begin to grow inward, towards the eye itself. Eventually, the pointed ends of the eyelashes touch and rub against the surface of your eye, leading to redness and irritation. Over time, the ingrowing eyelashes may actually scratch the surface of the eye.

The extent of the eye damage caused by trichiasis depends on the direction in which the eyelashes grow and how close they grow to the surface of your eye. In severe cases, this can cause damage to the cornea, and can even lead to irreversible blindness. According to the World Health Organisation, trichiasis has caused vision impairment and/or blindness in approximately 1.9 million people. 

Causes and risk factors

Your risk of developing trichiasis can be influenced by multiple factors, including:

  • Previous or current infection with the bacterium Chlamydia trachomatis 
  • Environmental factors
  • Age and gender
  • Eye irritation (or exposure to conditions that irritate your eyes or make them dry)
  • Individual susceptibility
  • Location

We will now discuss some of these risk factors in greater detail.

Infection

Trachoma is a highly contagious bacterial caused by a bacterium called Chlamydia trachomatis. It primarily affects the conjunctiva - the clear membrane that covers the white of the eye and the inside of the eyelids. Repeated or chronic trachoma infections can cause the conjunctiva to become thickened and distorted, as well as scarring and damage to other eye tissues. Over time, this tissue scarring can cause the eyelid to turn inward, triggering abnormal eyelash growth and the beginning of trichiasis. 

Environmental factors

Various environmental factors such as personal hygiene, dust levels, climate, and crowded living conditions all contribute to the spread of trachoma infection and, in turn, trichiasis. In areas with limited access to clean water and sanitation facilities, the risk of trachoma transmission is higher. Similarly, dry and dusty environments can irritate the eyes, making it more likely that a person rubs and touches their eyes.

Research indicates that hot and arid climates influence the prevalence of trachoma, with outbreaks often occurring during droughts.2 Even if the climate is not dry, other factors such as limited economic opportunities, access to health care, and educational awareness can also contribute towards the spread of trichiasis.

Age and gender

Trichiasis is most prevalent in young children, particularly in areas where infection with the bacterium Chlamydia trachomatis is common and in dry environments. If left untreated, trachoma can progress over time, causing scarring and vision problems in adulthood. Similarly, gender disparity is also present in some communities, where individuals assigned as female at birth are more likely to be affected than individuals assigned as male at birth. 

Signs and symptoms

The signs and symptoms of trachoma may initially be mild, but can become more severe over time if left untreated. In the early stages, trachoma causes conjunctivitis (commonly known as pink eye), which causes symptoms such as: 

  • Itching 
  • Redness 
  • Irritation of the eyes and eyelids 
  • Discharge from eyes 
  • Increased sensitivity to light
  • Feeling like there is a foreign body in the eye
  • Blurred vision
  • Eye pain

If conjunctivitis is not treated appropriately, it can lead to scarring of the inside of the eyelid. In extreme cases, it can lead to the development of corneal ulcers and, eventually, vision loss. 

Diagnosing trichiasis

Clinical examination

Trained healthcare professionals, such as ophthalmologists or optometrists, can diagnose trachoma through a thorough eye examination. Specifically, they will look for inflammation of the conjunctiva, the presence of follicles (small bumps) inside the eyelids, and evidence of scarring.

Ocular surface staining

Ocular surface staining is a simple diagnostic technique also known as VIA or visual inspection with acetic acid. As the name suggests, drops of 3-5% acetic acid solution are applied to the conjunctiva of the eye. This causes rough areas such as follicles to turn white and become more visible during examination.

Other diagnostic tests

Other diagnostic tests include:

  • Inverting the eyelid to check for any in-growing eyelashes
  • Laboratory tests for Chlamydia trachomatis. Your medical professional may swab your eyelid and then perform specialised diagnostic tests on the sample to confirm their diagnosis

Treatment

A licensed healthcare professional will carefully evaluate your symptoms and determine how severe and advanced your condition is. Depending on their findings, your doctor will formulate a tailored treatment plan for you. This may include:3 

Antibiotics

The World Health Organisation recommends patients with trichiasis take two antibiotics: azithromycin, which is taken orally as tablets, and tetracycline eye ointment. 

Lubricating eye drops

As trachoma is more prevalent in areas with a dry climate, lubricating eye drops reduce dryness and irritation. They also help wash out any debris or dust in our eyes.

Surgical intervention

If the above treatments are delayed and your trachoma has advanced to the point where it may cause visual impairment and blindness, eyelid surgery may be necessary. In these procedures, a surgeon makes an incision in the scarred eyelid and folds the affected eyelashes away from the eye itself. This will prevent further scarring and loss of vision. If your vision has already become impaired, a corneal transplant may be necessary.

Prevention

Preventing trachoma requires a multifaceted approach that includes various public health measures and individual actions. These include:

  • Promoting good hygiene: one of the most important and simple preventative measures is hygiene. Promoting regular face and hand washing helps reduce the transmission of the bacterium Chlamydia trachomatis
  • Improving access to clean water: improved access to clean water sources, proper sanitation, and controlling fly populations (which act as carriers of C. trachomatis) greatly decrease the incidence of trachoma infections in communities
  • Wear protective eyewear: if you work in environments where there is a risk of eye injury, wearing protective eyewear can help prevent trauma or injury
  • Regular eye check-ups: you should schedule regular eye check-ups with your ophthalmologist, especially if you are at a higher risk of developing trichiasis due to your medical history or profession

Prognosis

Early detection and treatment

The best approach towards trachoma can be adopted if it is diagnosed early. If trachoma is diagnosed and treated in its early stages, especially during the active stages of infection, the prognosis is generally good. Antibiotics and lubricating eye drops are very effective in managing trachoma in its early stages. 

Long-term outlook

If trichiasis is not resolved early, it may advance - making prognoses less favourable. Corneal damage and visual impairment are more likely in this stage. Whilst the surgery may provide some relief for patients with advanced trichiasis, it may not fully reverse the corneal damage or vision loss that may have already occurred.

FAQ’s

What is trachoma, and how does it relate to trichiasis?

Trachoma is an eye disease caused by the bacterium Chlamydia trachomatis. Trichiasis is a condition associated with trachoma, where the eyelashes turn inward and irritate the eye. 

What are the common symptoms of trachoma?

Trachoma typically causes redness and inflammation of the eye (conjunctivitis), watery discharge, itching, and irritation. In advanced stages, it can lead to inward-turning eyelashes (trichiasis) and corneal damage.

What causes trachoma?

Trachoma is often caused by the bacterium Chlamydia trachomatis. The infection leads to inflammation, tissue damage, and scarring in the eye, which can progress to trichiasis when left untreated.

What are the environmental factors contributing to trachoma?

Environmental factors that influence an individual’s risk of trachoma include poor sanitation, lack of clean water sources, crowded living conditions, dry and dusty environments, and the presence of flies that can transmit the disease.

How can trachoma be diagnosed?

Trachoma is diagnosed through clinical examination, visual inspection with acetic acid, eyelid inversion, and, in some cases, laboratory tests to confirm the presence of Chlamydia trachomatis.

What are the key prevention measures for trachoma?

 Preventing trachoma involves promoting good hygiene practices, handwashing, improving sanitation, conducting mass drug administration (MDA) campaigns with antibiotics, promoting the construction of latrines, controlling fly populations, and raising awareness.

Summary

Trichiasis, a condition linked to the eye infection trachoma, remains a critical global health issue. This article has covered trichiasis, its prevalence, causes, symptoms, and the importance of prevention and early treatment. Prompt medical attention helps prevent the condition from progressing and causing irreparable damage to your eyes and sight.

As such, it is vital to educate populations about how to reduce their risk of trichiasis and protect their eye health. This is possible only if we increase awareness among the public, improve water treatment and sanitation, and educate at-risk populations. Whilst this will require a multifaceted and collaborative approach, it is possible for everyone to have accessible health care and education regarding conditions such as trichiasis, as well as the challenges associated with it.

References

  1. Flueckiger RM, Courtright P, Abdala M, Abdou A, Abdulnafea Z, et al. The global burden of trichiasis in 2016. PLOS Negl. Trop. Dis. 2019;13(11):e0007835
  2. Ramesh A, Kovats S, Haslam D, Schmidt E, Gilbert CE. The Impact of Climatic Risk Factors on the Prevalence, Distribution, and Severity of Acute and Chronic Trachoma. PLOS Negl. Trop. Dis. 2013;7(11):e2513 
  3. Rajak SN, Collin RO, Burton MJ. Trachomatous Trichiasis and its Management in Endemic Countries. Surv. Opthalmol. 2012; 57(2):105-135. 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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