WHAT IS TRICHIASIS?
Eyelashes typically grow out and away from the ocular surface. Trichiasis is the misdirection of eyelashes toward the globe. This misdirection may be severe and cause the eyelashes to touch the ocular surface.
WHAT ARE THE SYMPTOMS OF TRICHIASIS?
It can be asymptomatic or cause pain, foreign body sensation, light sensitivity, red eyes, tearing, and corneal scratches (on the clear front part of the eye) leading to infection and scarring. If the lashes touch the ocular surface over a long period of time, the patient may become desensitized and stop having symptoms. This can be problematic as irreversible damage to the cornea can occur without the patient knowing.
WHAT ARE THE CAUSES?
Eyelash growth changes with age and so may often be temporary. Behaviors, such as frequent eye rubbing, can also mechanically turn the lashes inwards. Inflammatory conditions of the eyelids and eyelashes (e.g. Blepharitis) can also impair eyelash growth. Some children have a congenital malformation of the eyelids, such as epiblepharon. This occurs because of an extra fold of eyelid skin on the lower lid that pushes the lashes into a vertical position. It is often noted shortly after birth and is most commonly seen in children of Asian or Hispanic ancestry. Finally, accessory or extra eyelashes may grow in an abnormal way. This is known as distichiasis.
WHAT IS THE TREATMENT?
Often this is a temporary issue for children and no treatment is necessary other than observation. Artificial tear ointment may be prescribed to protect the surface of the eye. If there is a scratch on the eye, antibiotic drops may be necessary. A short-term solution may involve manually pulling the misdirected lashes, but they typically grow back short and stiff in 6-8 weeks and can be more irritating. If there are signs of infection, scarring or vision loss, the lash follicles can be destroyed in the operating room using cautery or another method. If the cause is epiblepharon, surgery can be done to remove the excess skin and rotate the eyelid into a more normal position.