Trichiasis is a disease of the organ of vision, accompanied by an abnormal direction of eyelash growth. Clinically, the pathology is manifested by hyperemia of the eyes, photophobia, pain in the projection area of the eye socket, increased lacrimation. Diagnosis of trichiasis includes the collection of anamnesis, external examination, biomicroscopy, visometry. Minimally invasive (diathermocoagulation, electrolysis, argonlaser coagulation, cryotherapy) or surgical techniques are used for treatment. The essence of surgical intervention is reduced to a through resection of the area with the wrong direction of eyelash growth. In generalized trichiasis, reconstructive surgery is recommended.
Trichiasis is a pathology of the location of eyelashes, in which the growth zone of the hair follicles is shifted towards the eyeball. Pathological growth of eyelashes is a widespread phenomenon, however, accurate statistical information is not available due to the low access of patients to specialists with a mild course. Usually the disease is acquired, congenital forms are less common. Trichiasis is detected with the same frequency among males and females. It is more often diagnosed in elderly people. It is found everywhere in practical ophthalmology. The founder of the technique of operative correction of generalized trichiasis is the Russian professor V. N. Kanyukov, who in 1991 proposed a technique for expanding the intermarginal space by rotating rhomboid segments of cartilage.
One of the most common causes of trichiasis is scarring of the free edge of the eyelids. Pathological keloid scars can occur with ocular scarring pemphigoid or trachoma, lead to displacement of hair follicles, followed by a change in the direction of eyelash growth. Less often, trichiasis has an iatrogenic origin, which is associated with the formation of defects on the eyelids in the postoperative period. Cases of acquired pathology after traumatic injuries or burns with chemicals are described. The cause of the development of trichiasis may be a chronic or acute course of blepharitis in the anamnesis, which also causes deformation of the eyelash growth line.
Less often, the triggers of this disease are represented by degenerative or keloid changes in the orbital or palpebral conjunctiva. As a result of such changes, entropion develops, the concomitant pathology of which is trichiasis. It is often not possible to establish the etiology of the congenital form of the disease, which suggests its sporadic development. In rare cases, there is a relationship between the occurrence of pathology and persistent herpetic infection in the anamnesis. The pathogenesis of the clinical picture of trichiasis is a violation of the mechanism of production of lacrimal fluid associated with the hypofunction of goblet cells and compensatory hypertrophy of the lacrimal gland. The increase in the size of the gland is associated with constant functional activity due to chronic irritation of the bulbar conjunctiva with eyelashes.
From a clinical point of view, there are local and diffuse forms of trichiasis. Pathology can be congenital or acquired. As a rule, the acquired form of the disease is unilateral, congenital damage to the organ of vision is more often binocular. If the eyelashes grow incorrectly, they constantly injure the orbital and palpebral conjunctiva. This leads to the development of superficial pinpoint keratopathy and conjunctival injection. Patients with trichiasis complain of hyperemia of the eyes, photophobia, pronounced soreness in the projection area of the eye socket and constant lacrimation. The sensation of a foreign body in the eye causes frequent blinking, which does not bring relief, but only aggravates the clinical manifestations of trichiasis. Reflex blepharospasm develops less often.
The prolonged course of trichiasis aggravates the progression of spot keratopathy and the formation of erosions of the cornea. Secondary changes may provoke a slight decrease in visual acuity or a spasm of accommodation. Injury to the skin leads to the appearance of small ulcers that do not heal for a long time due to the ingress of tear fluid on them. With generalized trichiasis, patients note an increase in headache when looking at a light source. In addition to pronounced discomfort, trichiasis manifests itself as a cosmetic defect.
Diagnosis of trichiasis is based on anamnestic data, results of external examination, biomicroscopy, visometry. The etiology of this disease is indicated by such anamnestic information as the presence of traumatic injuries, inflammatory processes of the eyelids or conjunctiva, chemical burns. Less often, patients note a burdened family history (the presence of trichiasis in close relatives). During an external examination, a local or generalized change in the growth zone of eyelashes, conjunctival injection, hyperemia of the eyelids, increased lacrimation is detected.
A detailed examination is carried out using biomicroscopy with a slit lamp. The method allows you to visualize erosive changes in the edges of the eyelids, the abnormal direction of the eyelash growth zone, pathological areas of contact of the eyelashes with the cornea. To study changes in the cornea and orbital conjunctiva in trichiasis, biomicroscopy is performed using a dye and a blue cobalt filter. Fluorescein stains areas of spot keratopathy, erosive changes of the cornea, conjunctival lesions, which makes them available for visualization. Visometry is an auxiliary research method for detecting changes in visual acuity. A prolonged course of trichiasis leads to a spasm of accommodation, and secondary changes lead to minor myopia.
Differential diagnosis of trichiasis is performed with entropion, epiblepharone and distichiasis. With entropion, the area of the eyelashes does not change, there is a turn of the eyelid, which entails a secondary appeal of the eyelashes towards the eyeball. Unlike trichiasis, epiblepharone in most cases is a genetically determined pathology with the greatest prevalence among persons of the Mongoloid race. The direction of the eyelashes in this pathology changes due to the formation of an additional skin fold on the lower eyelid. With distichiasis, the growth zone of the eyelashes is not changed, traumatization of the orbital conjunctiva and cornea occurs due to an additional row of eyelashes.
The tactics of treating trichiasis depends on the form of the disease. In case of local lesion, the method of choice is diathermocoagulation using a special needle-shaped electrode. The procedure is carried out during the growth of the eyelash up to its bulb. Also, with single changes, argonlaser coagulation can be used as a minimally invasive technique on the skin of the eyelid at the exit of the eyelash with abnormal growth. After coagulation for 3 days, it is recommended to use antiseptic drops or ointments before going to bed. A widely used method of treating trichiasis – eyelash epilation (removal with tweezers) is ineffective. Due to the rapid growth of eyelashes, the procedure must be repeated every 30 days.
It is possible to remove eyelashes with trichiasis using the electrolysis technique. In this case, the electrode of the electric scooter is applied to the hair bag and the tissue is coagulated. A side effect of the procedure is the formation of small scars in the area of the electric scooter. With common forms of trichiasis, surgical intervention is necessary. The essence of surgical treatment of trichiasis is reduced to the implementation of through resection of the area with improper growth of eyelashes, followed by convergence of the edges of the wound and layer-by-layer suturing.
In generalized trichiasis, the most effective method of treatment is the reconstruction of the posterior pole of the affected eyelid by grafting a flap from the mucous membrane of the patient’s lip. Also, as a material for plastics, you can use autochondria, canned aponeurosis. An alternative option is the rotation of diamond-shaped segments of cartilage or hair sacs. Minimally invasive technique in the generalized form of trichiasis is cryotherapy with liquid nitrogen. If the protocol of the procedure is not followed, the cells of the epithelial layer may die off. After removing eyelashes with the wrong direction of growth, patients with chiseled keratopathy are recommended to use an antibacterial ointment for 3 days to eliminate clinical symptoms.
Prognosis and prevention
There is no specific prevention of trichiasis. Non-specific preventive measures are reduced to compliance with safety regulations at work when working with acids and alkalis. For preventive purposes, all patients with a history of blepharitis are recommended to be monitored and treated promptly by an ophthalmologist. After traumatic injuries or burns to the eyes, the rib edge of the eyelid should be carefully sutured or an ankyloblepharone should be formed. To prevent the development of frequent relapses of trichiasis, specific therapy should be carried out only by a specialist.
The prognosis for life and work capacity in trichiasis is favorable. In the absence of timely treatment, a slight decrease in visual acuity or the addition of secondary complications is possible.