Trichiasis

BASICS


DESCRIPTION


• Acquired misdirection or inturning of eyelashes in an otherwise normal eyelid margin position


• Distichiasis—abnormal hair growing from meibomian gland openings


EPIDEMIOLOGY


Incidence


• Cicatricial—ocular cicatricial pemphigoid (OCP)—females >males


• Average age 60–70 years


Prevalence


Cicatricial—OCP—1 in 15,000–20,000 (1)


RISK FACTORS


Genetics


OCP—associated with HLA—DQB7301


PATHOPHYSIOLOGY


• Distichiasis—hair grows from poorly differentiated pilosebaceous units


• Trachoma–-Chlamydial infection


• Ocular pemphigoid—autoimmune


ETIOLOGY


• Usually unknown


• Scarring of eyelid margin


• Prostaglandin analog eyedrops


• OCP–-a systemic autoimmune pemphigoid disorder that has ocular and nonocular manifestations


– OCP thought to be a type 2 hypersensitivity reaction, genetically predisposed


COMMONLY ASSOCIATED CONDITIONS


• Uncommon:


– Ocular pemphigoid


– Trachoma


DIAGNOSIS


HISTORY


• Foreign body sensation


• Tearing


• Redness


• Previous chemical or physical trauma


PHYSICAL EXAM


• Inturned eyelashes abrading globe with normal position of eyelid margin


• Superficial punctuate keratopathy or corneal abrasions


• Chronic blepharitis


• Eyelid or conjunctival scarring


• Symblepharon—cicatricial—linear scar/fold of palpebral conjunctiva to bulbar conjunctiva, shortening of fornix


– Scarring of upper eyelid tarsal conjunctiva on eyelid eversion (trachoma)


DIAGNOSTIC TESTS & INTERPRETATION


Imaging


Initial approach

• None


• OCP—ANA


Follow-up & special considerations

OCP—elevated soluble CD 8 glycoprotein, elevated tumor necrosis factor


Diagnostic Procedures/Other


Cicatricial—conjunctival biopsy


Pathological Findings


OCP—biopsy of conjunctiva for direct immunofluorescence studies or indirect immunofluorescence for presence of antibodies—positive in >80%


DIFFERENTIAL DIAGNOSIS


• Entropion


• Epiblepharon


• Epicanthus


TREATMENT


MEDICATION


First Line


• Ocular lubrication


– Frequent artificial tears, ophthalmic ointment


• Treat underlying blepharitis


Second Line


Single-dose oral azithromycin (1 g) for trachoma—household member treatment does not improve prognosis (2)


ADDITIONAL TREATMENT


General Measures


Epilation of lashes—recurrence very common every 2–6 weeks


Issues for Referral


Ophthalmologist 1 week


Additional Therapies


• Bandage contact lens


• OCP—prednisone, dapsone, methotrexate, cyclophosphamide, CellCept, or doxycycline


SURGERY/OTHER PROCEDURES


• Procedures to destroy eyelash follicle


– Electrolysis or cautery


– Cryotherapy


– Laser


– Radiofrequency


• Surgical cutting procedures


– Trephination, excision of follicles


– Eyelid splitting and cryo


– Eyelid resection


– Eyelid margin rotation


– Anterior lamellar resection


ONGOING CARE


FOLLOW-UP RECOMMENDATIONS


Eyelashes regrow in few weeks


Patient Monitoring


Ophthalmologist – outpatient


PATIENT EDUCATION


• Warning signs of ocular irritation


• Trachoma is one of the most important and prevalent eye diseases in the world


PROGNOSIS


• Lashes will almost always regrow; follicles are not damaged by epilation


• Trachoma—cycles of infection, inflammation, scarring, and increased trichiasis and entropion


• Ocular pemphigoid—stabilize if possible with


COMPLICATIONS




ALERT


Corneal abrasion, ulcer, scarring, opacity, perforation, vascularization, and blindness (3)[C]




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Nov 9, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Trichiasis
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