Trichiasis
👁️ Trichiasis
🔍 Definition
Trichiasis is a condition where eyelashes grow inward, toward the eyeball, and rub against the cornea and conjunctiva, causing irritation, inflammation, and possibly corneal damage.
✅ The eyelid margin is in a normal position — unlike entropion (where the lid itself turns inward).
🧬 Etiology (Causes)
| Category | Examples |
|---|---|
| Idiopathic | Common in elderly without clear cause |
| Infectious | Trachoma (Chlamydia trachomatis), Herpes zoster |
| Inflammatory | Blepharitis, Stevens-Johnson syndrome |
| Autoimmune | Ocular cicatricial pemphigoid |
| Trauma/Surgery | Scarring from burns, lid injuries, previous surgery |
| Congenital | Rarely present from birth |
👀 Clinical Features
| Sign / Symptom | Description |
|---|---|
| Foreign body sensation | “Something in the eye” feeling |
| Redness (conjunctival injection) | Due to irritation from lashes |
| Tearing (epiphora) | Reflex tearing to flush irritant |
| Photophobia | Light sensitivity from corneal irritation |
| Blurred vision | If corneal surface is scratched or damaged |
| Corneal epithelial defects | Seen on fluorescein stain exam |
🧪 Diagnosis
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Slit-lamp exam – shows misdirected lashes rubbing on cornea
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Fluorescein staining – highlights abrasions or ulcers
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Eversion of lid – to rule out entropion or embedded foreign body
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History – trauma, surgery, infection
💊 Treatment
🔹 Temporary Relief
| Method | Use |
|---|---|
| Lubricant eye drops/ointment | Reduce friction and protect cornea |
| Epilation (lash removal with forceps) | Quick fix, but lashes regrow in weeks |
| Bandage contact lens | Protects cornea from lash trauma |
🔹 Definitive / Recurrent Cases
| Procedure | Description |
|---|---|
| Electrolysis | Electric current destroys lash follicles |
| Cryotherapy | Freezing lash follicles to destroy them |
| Radiofrequency ablation | Thermal destruction of follicles |
| Lid margin rotation surgery | For severe or scarring-associated cases |
⚠️ Complications
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Corneal ulcer
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Corneal scarring
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Vision loss
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Chronic conjunctivitis
🔁 Differential Diagnosis
| Condition | Key Feature |
|---|---|
| Entropion | Eyelid turns inward (plus trichiasis) |
| Distichiasis | Extra row of lashes from meibomian glands |
| Pseudotrichiasis | Lashes touch cornea due to entropion |
🧠 Mnemonic: “Tricky Lashes” = Trichiasis
-
Tricky lashes grow the wrong way → scratch the cornea.
📋 Quick Summary Table
| Feature | Trichiasis |
|---|---|
| Lid position | Normal |
| Lash direction | Inward, touching cornea |
| Causes | Infections, inflammation, trauma |
| Symptoms | FB sensation, tearing, photophobia |
| Treatment | Epilation, electrolysis, cryotherapy |
Would you like:
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A side-by-side diagram of trichiasis vs entropion?
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A case study question for revision?
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Or a clinical flashcard?
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