TRICHIASIS

It refers to inward misdirection of cilia (which rub
against the eyeball) with normal position of the lid
margin (Fig. 14.16A). The inward turning of lashes
along with the lid margin (seen in entropion) is called
pseudotrichiasis.
Etiology. Common causes of trichiasis are : cicatrising
trachoma, ulcerative blepharitis, healed membranous
conjunctivitis, hordeolum externum, mechanical
injuries, burns, and operative scar on the lid margin.
Symptoms. These include foreign body sensation
and photophobia. Patient may feel troublesome
irritation, pain and lacrimation.
Signs. Examination reveals one or more misdirected
cilia touching the cornea. Reflex blepharospasm and
photophobia occur when cornea is abraded.
Conjunctiva may be congested. Signs of causative
disease viz. trachoma, blepharitis etc. may be present.
Complications. These include recurrent corneal
abrasions, superficial corneal opacities, corneal
vascularisation (Fig. 14.16B) and non-healing corneal
ulcer.
Treatment. A few misdirected cilia may be treated by
any of the following methods:
1. Epilation (mechanical removal with forceps): It is
a temporary method, as recurrence occurs within
3-4 weeks.
2. Electrolysis: It is a method of destroying the lash
follicle by electric current. In this technique,
infiltration anaesthesia is given to the lid and a
current of 2 mA is passed for 10 seconds through
a fine needle inserted into the lash root. The
loosened cilia with destroyed follicles are then
removed with epilation forceps.
3. Cryoepilation: It is also an effective method of
treating trichiasis. After infiltration anaesthesia, the
cryoprobe (–20 °C) is applied for 20-25 seconds to
the external lid margin. Its main disadvantage is
depigmentation of the skin.
4. Surgical correction: When many cilia are
misdirected operative treatment similar to cicatricial
entropion should be employed.