Trichiasis masquerading as dry eye disease
What is it? Trichiasis is a condition where eyelashes (one or many) are misdirected onto the cornea or conjunctiva. The mechanism of injury is from friction and the constant rubbing over months and years can cause severe corneal abrasions, infections (ulcers) and can result in irreversible scarring and result in vision loss.
Masquerading as dry eye. It is not uncommon to have a patient who feels (or has been told) that they have dry eye disease, but in fact, the most bothersome symptoms are primarily from eyelash rubbing. Dry eye and trichiasis are often interrelated and share many common causes (see below), but is important to differentiate between these entities.
Video: The video shown here shows corneal scarring from trichiasis. Ocular rosacea co-exists as well.
Causes: The cause of trichiasis is often just benign, such as an anomalous position of the eyelid (entropion) or of the eyelash follicle itself. However, trichiasis can be caused by trauma, chronic eyelid infections (like dry eye, ocular rosacea, meibomian gland dysfunction), or more serious conditions such as eyelid cancers or autoimmune conditions. Rare conditions of the skin and mucous membranes such as Stevens-Johnson syndrome and cicatricial pemphigoid can also pre-dispose to trichiasis.
Trachoma: A special mention of Trachoma. Trachoma is an infectious condition where the eyelid becomes scarred from blepharoconjunctivitis from Chlamydia trachomatis infection. The eyelid scarring causes entropion (inward turning of the eyelid) and trichiasis involving the entire lash line which can lead to severe corneal scarring. Trachoma is the world’s leading cause of infectious blindness. It is easily preventable with proper hygiene, antibiotics, and early detection.
Treatments: Treatments range from simple manual or electro epilation techniques that provide relief, but often only temporary. Ablation surgery uses radiofrequencies or lasers to remove the lashes and hair follicles. Cryosurgery is another option but can result in poor cosmesis and dry eye from lid malposition. Other oculoplastic surgical methods such as eyelid rotation to resection of a notch of the eyelid have also been used. Recently, several research abstracts on the use of intense pulse light (IPL) have been described for treatment of trichiasis.