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PubMed2005

A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia.

BACKGROUND/AIM: Trachomatous trichiasis frequently returns following surgery. Several factors may promote recurrence: preoperative disease severity, surgeon ability, surgical procedure, healing responses, and infection. This study investigates whether enhanced control of infection, both of Chlamydia trachomatis and other bacteria, with azithromycin can improve surgical outcome in a trachoma control programme. METHODS: Individuals with trachomatous trichiasis were examined and operated. After surgery patients were randomised to the azithromycin or control group. The azithromycin group and children in their household were given a dose of azithromycin. Antibiotic treatment was repeated at 6 months. All patients were reassessed at 6 months and 12 months. Samples were collected for C trachomatis polymerase chain reaction and general microbiology at each examination. RESULTS: 451 patients were enrolled. 426 (94%) were reassessed at 1 year, of whom 176 (41.3%) had one or more lashes touching the eye and 84 (19.7%) had five or more lashes. There was no difference in trichiasis recurrence between the azithromycin and control group. Recurrent trichiasis was significantly associated with more severe preoperative trichiasis, bacterial infection, and severe conjunctival inflammation at 12 months. Significant variability in outcome was found between surgeons. Visual acuity and symptoms significantly improved following surgery. CONCLUSION: In this setting, with a low prevalence of active trachoma, azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme. Audit of trichiasis surgery should be routine.

Aged↗

PubMed1990

A trial of surgery for trichiasis of the upper lid from trachoma.

Three surgeons operated on upper eye lids of northern Omani villagers for trichiasis due to trachoma using a standardised protocol. The lids were graded as minor trichiasis, five or fewer lashes; major trichiasis, six or more lashes; and lid closure defect. Operative success was defined as no lash/eyeball contact and complete gentle lid closure. One hundred and sixty five lids with major trichiasis were allocated by random number tables to one of five operations: bilamellar tarsal rotation (Ballen), tarsal advance and rotation (modified Trabut), eversion splinting (grey line), tarsal advance (lid split), and tarsal grooving (Streatfield-Snellen) operations. Bilamellar tarsal rotation was significantly more successful than eversion splinting (chi 2 = 7.0, p less than 0.01); tarsal advance (chi 2 = 12.4, p less than 0.001), and tarsal grooving (chi 2 = 23.7, p less than 0.001), but not significantly more successful than tarsal advance and rotation (chi 2 = 2.9, p greater than 0.05). Two of 32 (6%) lids with lid closure defect were successfully treated with tarsal advance; trichiasis was relieved in nine and lid closure defect in 10. It is suggested that bilamellar tarsal rotation and tarsal advance and rotation are effective operations for major trichiasis, but tarsal advance is ineffective where trichiasis and lid closure defect coexist.

Adult↗

PubMed2005

Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology.

Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.

Adolescent↗

PubMed2004

Gender equity and trichiasis surgery in the Vietnam and Tanzania national trachoma control programmes.

AIMS: To calculate the gender distribution of trichiasis cases in trachoma communities in Vietnam and Tanzania, and the gender distribution of surgical cases, to determine if women are using surgical services proportional to their needs. METHODS: Population based data from surveys done in Tanzania and Vietnam as part of the national trachoma control programmes were used to determine the rate of trichiasis by gender in the population. Surgical records provided data on the gender ratio of surgical cases. RESULTS: The rates of trichiasis in both countries are from 1.4-fold to sixfold higher in females compared to males. In both countries, the female to male rate of surgery was the same or even higher than the female to male rate of trichiasis in the population. CONCLUSIONS: These data provide assurance of gender equity in the provision and use of trichiasis surgery services in the national programmes of these two countries. Such simple analyses should be used by other programmes to assure gender equity in provision and use of trichiasis surgery services.

Eyelashes↗

PubMed1982

Cryosurgery in treatment of trichiasis.

Ten patients with trichiasis were treated with cryosurgery by the standard retinal probe with nitrous oxide. A double freeze-thaw method was used. Nine of the patients had trachomatous trichiasis and one had conjunctival scarring. In only the latter case were the lashes destroyed, and these grew again after 2 months. Trachomatous trichiasis is frequently associated with entropion. The tarsal plate in such cases is often thickened and distorted, with extensive conjunctival scarring. The success of cryosurgical treatment of trichiasis depends not only on the type of probe used but perhaps also on the aetiology of the disease. To our knowledge no similar trial of this form of treatment of trichiasis has been carried out in eye centres in Africa south of the Sahara. Cryosurgery is simple to perform and of great potential use, particularly in areas where there is a shortage of skilled surgeons to perform the delicate eyelid operations often required in trichiasis.

Cryosurgery↗

PubMed1990

The management of trachomatous trichiasis.

Trachoma is the cause of one-quarter of world blindness. Corneal damage from trachoma is related to trichiasis, which may affect over 10% of adults in endemic communities. Relief of trichiasis is believed to prevent corneal damage and the provision of community-based lid surgery is a central strategy for trachoma control programs. This strategy is weakened by the dearth of information on the effectiveness of different trichiasis procedures. A systematic review of trichiasis surgery is presented and reports of treatment efficacy are reviewed. Conclusions are drawn as to which procedures seem most appropriate for trachomatous trichiasis in prevention of blindness programmes. It is suggested that further controlled clinical trials of appropriate trichiasis procedures are needed.

Blindness↗

PubMed2006

Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia.

BACKGROUND: Trichiasis recurrence following surgery is a serious problem for trachoma programs. OBJECTIVE: To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient. DESIGN: A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks). MAIN OUTCOME MEASURES: Trichiasis recurrence within 1 year following surgery. RESULTS: The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19). CONCLUSIONS: In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Administration, Oral↗

PubMed2003

Modified grading system for upper eyelid trachomatous trichiasis.

AIM: This study was conducted to determine the level of inter-observer agreement in the modified grading scheme for trichiasis of the upper eyelid. METHODS: A grading system that covers the entire spectrum of trachomatous trichiasis, extending from the simple to the severe forms, was initially developed by the first and second authors and field-tested. The grading scheme recognizes three levels of severity, based on deviation of the lid margin (TT1, TT2 and TT3); and four anatomical locations indicating where the eyelashes touch the globe in TT1 (nasal, central, temporal, or combined). The grading of trichiasis patients was then conducted on the basis of the modified grading scheme. RESULTS: The inter-observer agreement between the grades of simple trichiasis (TT1) and entropion (TT2) using Cronbach's alpha was 0.84, and the agreement within each sub-grade was 0.86. The weighted Kappa value was 0.68 (95% CI 0.57-0.79) for the main grades and 0.49 (95% CI 0.23-0.79) for the sub-grades. CONCLUSIONS: The inter-observer agreement was very reliable and could easily be attained by all levels of ophthalmic professionals. As the grading follows the natural progression of trichiasis from the simple to the severe forms in relation to the anatomical site involved, it helps to determine the degree of correction and how far to extend the surgical incision.

Eyelashes↗

PubMed1993

Treatment of localized trichiasis with radiosurgery.

Several treatments exist for trichiasis, a condition in which misdirected lashes come in contact with the globe. The treatments can be considered in two groups, those that destroy the lash follicle and those that redirect the lashes. No technique is without potential complications, and none is 100% effective. The Ellman Surgitron FFPF offers a new treatment for trichiasis directed at destroying the lash follicle. This instrument utilizes energy at 3.8 MHz in the radiofrequency band of the electromagnetic spectrum, hence the term radiosurgery. This report presents a prospective, non-masked study of 30 eyelids in 26 patients with localized trichiasis treated with the Ellman Surgitron FFPF. Single treatment success rate in patient cure was 67%. Complications included lash recurrence in 8 patients, eyelid notching in 2, granuloma formation in 1, and persistent erythema and tenderness for 1 month in 1 patient. This series demonstrates that the instrument can be effectively used to treat localized trichiasis. A review of the literature reveals that this technique offers potential advantages over some others in use. Further study must determine its efficacy in the treatment of diffuse trichiasis and distichiasis.

Aged↗

PubMed2005

Cicatricial entropion and trichiasis in an urban Australian population.

BACKGROUND: Cicatricial entropion and trichiasis may be caused by a variety of diseases, of which trachomatous entropion is the commonest worldwide. The spectrum of disease in the authors' community is quite different. The purpose of this study was to establish the aetiology of entropion and trichiasis in patients referred to a Melbourne-based subspecialty oculoplastics practice, excluding epiblepharon, congenital entropion and involutional entropion, and to compare the final diagnosis with the referring diagnosis. METHODS: All records of patients with cicatricial entropion and trichiasis presenting to the practice of one of the authors over the period 1990-2000 were analysed. Demographic data, referring diagnosis and final diagnosis were tabulated. RESULTS: The commonest final diagnosis was ocular cicatricial pemphigoid. In only a small proportion of cases was this diagnosis considered by the referring practitioners. In addition, two cases of undiagnosed conjunctival neoplasia presented with entropion and trichiasis. CONCLUSION: In all patients with entropion and trichiasis, a careful history and examination should be obtained and appropriate investigations performed to try and establish a firm diagnosis.

Adult↗

PubMed2006

The association between epilation and corneal opacity among eyes with trachomatous trichiasis.

AIM: To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery. METHODS: Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status. RESULTS: Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated. CONCLUSION: Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.

Corneal Opacity↗

PubMed2005

Risk factors for postsurgical trichiasis recurrence in a trachoma-endemic area.

PURPOSE: The World Health Organization recommends trichiasis surgery to prevent blindness caused by trachoma; however, recurrence is common. Risk factors for recurrence have not been widely studied, particularly in trachoma hyperendemic areas. METHODS: Three hundred ninety-four persons with trichiasis in Tanzania were examined. Participants had undergone surgery >18 months before the study. Trichiasis recurrence and active trachoma at study visit were assessed. Ocular swabs were collected and tested for Chlamydia trachomatis. Household members were examined for active trachoma. RESULTS: Of the surgical eyes, 28% had recurrence; 40% of patients had recurrence in one or both eyes. Rates did not vary by time since surgery. Eye-level recurrence rates varied significantly across districts, ranging from 16% to 38%. Current chlamydial infection among surgical cases was low (6%) and was not associated with recurrence. Recurrence was associated with tarsal conjunctival inflammation (OR: 2.4; 95% confidence interval [CI]: 1.6-3.8) and residence in the Kongwa district (OR: 2.3; 95% CI: 1.2-4.6). CONCLUSIONS: Recurrence after trichiasis surgery is high, suggesting that vigilant follow-up in surgical cases is needed to reduce blindness. Recurrence is associated with evidence of inflammation in the tarsal conjunctiva, although it is not clear whether the inflammation contributes to recurrence, or is a result of the recurrence. Longitudinal studies of trichiasis patients after surgery are needed.

Aged↗

PubMed2006

Health-related quality of life in patients with trachomatous trichiasis or entropion.

PURPOSE: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. METHODS: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision = 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. RESULTS: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision = 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. CONCLUSIONS: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.

Adult↗

PubMed1993

Risk factors for trichiasis in women in Kongwa, Tanzania: a case-control study.

Women are at a greater risk compared to men for blinding complications from trachoma. In order to evaluate risk factors in women, 205 cases of trichiasis (TT) were selected from 11 villages in rural Tanzania. Each case of trichiasis was matched to two women of the same age and from the same village, who had no clinical signs of trachoma. Factors associated with trichiasis in a conditional logistic regression included history of trichiasis in the women's mother (odds ratio [OR] = 3.6; 95% confidence interval [CI]: 2.0-6.5); sleeping in a room with a cooking fire during childbearing years (OR = 1.8; 95% CI: 1.2-2.8); a home of wood and earth during childbearing years (OR = 2.1; 95% CI: 1.3-3.3); no adult education classes (OR = 2.2; 95% CI: 1.4-3.4); and five or more deaths among her children (OR = 2.6; 95% CI: 1.3-5.1). Detailed measures of prolonged exposure to child care as a young girl and as a mother showed no significant difference between cases and controls. Results from this study characterize women at high risk for severe disease and eventual blindness in a trachoma endemic area.

Adolescent↗

PubMed1993

Results of community-based eyelid surgery for trichiasis due to trachoma.

In many parts of Africa patients with upper-lid trichiasis due to trachoma have very limited access to ophthalmologists or hospital facilities. In order to reach these patients it is necessary for trained paramedical eye workers to operate on patients close to where they live. The results of trichiasis surgery performed by an ophthalmic nurse in Tanzania were evaluated. A total of 156 operations were performed on 94 patients over a 2 year period by an eye nurse in central Tanzania. One hundred and forty four eyes in 86 patients were followed for a minimum of 9 months (range 9-36; mean 25.5 months). One eye developed a wound infection and nine eyes developed minimal central notching of the upper eyelid, but without corneal exposure. Survival time analysis showed a probability of survival without recurrent trichiasis of 81% at 24 months (95% CI 74% to 88%) and 79% at 36 months (95% CI 71% to 87%). It is concluded that trichiasis surgery may be safely and effectively performed in the community by a trained ophthalmic nurse.

Blindness↗

PubMedDate not supplied

Thermoablation treatment for trichiasis in trachoma using the semiconductor diode pumped laser.

PURPOSE: The aim of this prospective study was to verify the efficacy of laser therapy for trichiasis in trachoma. Trichiasis is one of the most important complications of trachoma which is endemic in Sanliurfa, a city in the southeast of Turkey. METHODS: Twenty-eight eyelids of 22 patients - 15 males and 7 females - with trichiasis related to trachoma involving the upper, lower, or both lids, were included in the study and treated with a semiconductor diode-pumped, frequency-doubled, solid-state laser operating true CW at 532 nm. RESULTS: 19 (67.9%) of the lids were successfully treated in two sessions or less. Six lids (21.4%) required a third laser session and three (10.7%) a fourth session. Mild notching or dimpling occurred in two eyelids (5.6%). Postoperative swelling was minimal or absent. CONCLUSIONS: The results show that laser treatment may be successful for trichiasis caused by trachoma. Laser thermoablation is an effective and safe method, with many advantages over other modalities.

Aged↗

PubMedDate not supplied

Eyelid splitting and extirpation of hair follicles using a radiosurgical technique for treatment of trichiasis.

BACKGROUND AND OBJECTIVE: To describe a new, simple, and rapid surgical modification for the treatment of trichiasis. PATIENTS AND METHODS: In this noncomparative, prospective, interventional case series, 12 eyelids of 8 consecutive patients suffering from acquired trichiasis were treated by splitting the eyelid margin using a radiosurgical technique and then extirpating the hair follicles. The main outcome measure was successful resolution of trichiasis without recurrence during a follow-up period of at least 1 year. RESULTS: Complete recovery of the trichiatic eyelashes at the site of the treatment occurred in 10 of the 12 eyelids treated. There were no complications during or after healing of the surgical wound during the follow-up period. CONCLUSION: Radiosurgery provides a simple and rapid modification of the surgical treatment for acquired trichiasis, with good functional results.

Aged↗

PubMedDate not supplied

Distichiasis and dysplastic eyelashes in trachomatous trichiasis cases in Oman: a case series.

The study was a prospective evaluation of the prevalence of distichiasis and/or dysplastic eyelashes among trachomatous trichiasis cases at the oculoplasty unit of a hospital in Oman over 3 months in 2000. An oculoplasty surgeon examined and photographed cases using a bio-microscope. Out of 80 cases, 58 (72.5%) had abnormal eyelashes in addition to trachomatous trichiasis. The rate of distichiasis and dysplastic lashes were 13.8% (95% CI 6.2%-21.3%) and 33.8% (95% CI 23.5%-44.1%) respectively; 25.0% (95% CI 15.5%-34.5%) had both. Dysplastic and distichiasis eyelashes were significantly more prevalent in trachomatous trichiasis cases aged < 50 years and those with entropion. Presence of distichiasis and/or dysplastic eyelashes in trachomatous trichiasis cases warrants further analytical studies to confirm the observation and establish any causal association.

Adult↗