Kısa Yanıt
Trichiasis is a condition in which eyelashes are misdirected and grow inward, rubbing against the cornea and conjunctiva. Unlike entropion, the eyelid itself remains in its normal position. Chronic lash-cornea contact causes irritation, epithelial damage, and can lead to corneal scarring if untreated. Treatment targets the abnormal lash follicles through epilation, electrolysis, cryotherapy, or surgical excision.
What Is Trichiasis?
In trichiasis, one or more eyelashes grow inward toward the eye surface rather than outward. The misdirected lashes make continuous contact with the cornea and conjunctiva, causing mechanical abrasion with each blink. The condition may involve a few isolated lashes or an entire row.
Trichiasis should be distinguished from distichiasis, in which an extra row of lashes grows from the meibomian gland orifices (an abnormal location), and from entropion, where the entire lid margin turns inward.
Causes
- Chronic blepharitis: Long-standing lid margin inflammation alters lash follicle orientation.
- Trachoma: The leading infectious cause worldwide; repeated chlamydial conjunctivitis produces lid scarring and trichiasis.
- Cicatricial pemphigoid and Stevens-Johnson syndrome: Autoimmune and inflammatory conditions that cause conjunctival and lid margin scarring.
- Chemical or thermal burns: Scar tissue formation redirects lash growth.
- Previous eyelid surgery or trauma: Scarring near the lid margin can misdirect follicles.
- Idiopathic: In some patients, no identifiable cause is found.
Symptoms
- Foreign-body sensation -- the feeling of something in the eye
- Tearing and redness
- Stinging or burning, especially with blinking
- Photophobia (light sensitivity)
- Mucous discharge
- Blurred vision if the cornea becomes scarred
Diagnosis
The diagnosis is made during slit-lamp examination. Misdirected lashes touching the cornea or conjunctiva are directly observed. Fluorescein staining reveals punctate epithelial erosions or corneal abrasions in the area of lash contact. The underlying cause (blepharitis, scarring, entropion) is assessed to guide the treatment plan.
Treatment Options
Epilation (plucking)
Temporary removal of misdirected lashes with fine forceps. Provides immediate relief but lashes regrow in four to six weeks. Suitable as a short-term measure while planning definitive treatment.
Electrolysis
A fine needle delivers an electric current to destroy individual lash follicles. Effective for isolated lashes. Multiple sessions may be needed to achieve permanent results as not all follicles are destroyed on the first attempt.
Cryotherapy
A freeze-thaw cycle is applied to a segment of the lid margin to destroy abnormal follicles. Effective for multiple contiguous misdirected lashes. The procedure may cause temporary lid swelling, depigmentation of the treated area, and, rarely, notching of the lid margin.
Radiofrequency ablation
Uses radiofrequency energy directed at individual follicles. Offers precision similar to electrolysis with potentially less surrounding tissue damage.
Surgical excision with lid margin rotation
For diffuse trichiasis or when other methods have failed, a strip of lid margin tissue containing the abnormal follicles is excised, or the lash-bearing segment is rotated away from the eye surface. This approach provides the most definitive correction in severe cases.
Recovery
Day of procedure
Epilation and electrolysis are office procedures with no downtime. Cryotherapy or surgery may involve mild lid swelling and require lubricating drops and antibiotic ointment.
Days 1-3
After cryotherapy or surgery: swelling peaks and begins to subside. Cool compresses help. The treated area may feel tender.
Weeks 1-2
Sutures (if placed) are removed around day 7. Swelling resolves. Corneal symptoms improve as the abrasive lashes are no longer present.
Weeks 4-8
Final assessment. Any lash regrowth is identified and retreated if necessary. Corneal healing is evaluated with fluorescein staining.
Ne Zaman Acil Doktora Başvurmalı?
- •Persistent eye redness and pain despite lubricating drops (possible corneal abrasion or ulcer)
- •Decrease in vision associated with a painful, red eye
- •White or gray spot on the cornea (suspected corneal ulcer or scar)
- •Worsening symptoms after a trichiasis procedure (possible infection or significant inflammation)
- •Recurrence of misdirected lashes after previous treatment
Corneal damage from trichiasis can progress if untreated. Seek evaluation promptly.
Clinical Note
Even a single misdirected lash can cause disproportionate discomfort and, over time, meaningful corneal damage. The treatment choice depends on the number and distribution of affected lashes: electrolysis is ideal for a few isolated lashes, cryotherapy for a segmental row, and surgical excision or rotation for diffuse involvement. Equally important is identifying the underlying cause -- treating chronic blepharitis or addressing cicatricial changes reduces the likelihood of recurrence.
Frequently Asked Questions
Trichiasis Assessment
If you experience persistent irritation from eyelashes rubbing against your eye, schedule a consultation for evaluation and definitive treatment.
Memorial Bahçelievler Hastanesi, İstanbul
References & Sources
- American Academy of Ophthalmology (AAO). Preferred Practice Patterns — Oculoplastic Surgery.
- European Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS). Clinical Guidelines.
- Nerad JA. Smith and Nesi's Ophthalmic Plastic and Reconstructive Surgery. 4th ed. Springer; 2021.
- PubMed — U.S. National Library of Medicine. Oculoplastic surgery literature.
This page is for general informational purposes only and does not replace medical examination, diagnosis, or treatment. Each patient should be evaluated individually. Treatment decisions can only be made after an in-person consultation.
Results of any surgical or interventional procedure may vary from person to person. The information on this site does not guarantee any specific treatment outcome.
Medical review: Op. Dr. Burak Akbay — Göz Hastalıkları Uzmanı | FEBO
Published:
Last updated: