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PubMed2006

Folliculectomy: management in segmental trichiasis and distichiasis.

OBJECTIVE: To propose a new surgical technique as an alternative method for the correction of segmental trichiasis and distichiasis. MATERIAL AND METHOD: An interventional case series reviewed the segmental trichiasis and distichiasis patients who were treated with folliculectomy in the Ophthalmology Department, King Chulalongkorn Memorial Hospital. The data was collected from January 1997 to December 2002. The history, clinical features and treatments were reviewed. Patients with the initial diagnosis of entropion were excluded. RESULTS: Nine segmental trichiasis and distichiasis patients (13 eyes) were reviewed. Eight eyes underwent folliculectomy and one had folliculectomy with anterior lamellar recession. The follow-up time was 1-24 months. Nine of thirteen eyes (69.2%) were successfully treated with folliculectomy or folliculectomy with anterior lamellar recession. Four eyes needed second operations due to the recurrence of the eyelashes. CONCLUSION: Folliculectomy revealed good results in trichiasis and distichiasis. It should be considered as an alternative technique because it is a simple and fast procedure.

Adult↗
PubMed1994

Acceptance of surgery for trichiasis among rural Malawian women.

We sought to determine the proportion of women with trichiasis who subsequently accepted surgery and to evaluate factors related to acceptance. Women who accepted surgery were more likely to be widows, to be of low socioeconomic status, to live close to a main road, to know another woman who had surgery for trichiasis, and to have trichiasis in both eyes than women who did not accept surgery. Our results suggest that considerable education and encouragement are needed to increase acceptance of surgery for trichiasis.

Eyelashes↗
PubMed1994

Predicting surgical compliance in a cohort of women with trichiasis.

Trichiasis/Entropion are the severe consequences of chronic trachoma during early life. Blindness and vision loss is preventable with timely lid surgery to correct trichiasis. In a trachoma hyperendemic region of Central Tanzania, a two year follow-up survey was conducted among 205 women with trichiasis to determine the proportion who had had surgery and the barriers to having surgery. Only 18% of the women had undergone surgery by the 2 year follow-up. Those who had surgery tended to report more eye problems at baseline and have more corneal opacities at baseline. Barriers preventing women from going to surgery were costs, problem of children left at home alone, and difficulties in identifying someone to accompany them to the health center. Over 2/3 of those who had surgery reported a significant decrease in pain, improvement of vision, and improved ability to carry out activities of daily life. Ways to improve compliance with recommendations for trichiasis surgery need to be developed.

Adolescent↗
PubMedDate not supplied

Prospective evaluation of the argon laser treatment of trachomatous trichiasis.

PURPOSE: To evaluate the effectiveness of argon laser photocoagulation for the treatment of trachomatous trichiasis. METHODS: This report presents a prospective, non-masked study of 22 patients (36 eyelids) with trachomatous trichiasis treated with the argon laser. Each abnormal lash was treated with a beam of 50- to 200-micron spot size, for 0.2 seconds, and 1 to 1.2 watts power. In 30 lids (83.3%) infiltration anesthesia was used and in 6 lids (16.7%) no anesthesia was used. RESULTS: Successful treatment with no evidence of recurrence was achieved in 55.5% of lids after one laser session. The remaining 44.5% of the lids required two or three sessions. The final success rate of the method was 88.9%. No complications were observed. The mean follow-up time was 10.6 months. CONCLUSION: Argon laser photocoagulation is an effective and safe method for the treatment of trachomatous trichiasis.

Aged↗
PubMedDate not supplied

Evaluation of barriers to surgical compliance in the treatment of trichiasis.

PURPOSE: Eyelid repair surgery can prevent the effects of trichiasis leading to visual loss. Cost, transportation difficulties, and familial responsibilities have been identified as major barriers to surgical compliance. We evaluated whether offering trichiasis surgery in the village was effective in increasing the rate of surgical acceptance and in decreasing perceived barriers to surgery. METHODS: In 1989, 205 women with trichiasis were identified in Central Tanzania and were offered free surgery along with free transport. As of 1991, only 18% of these women had undergone the surgery. We followed-up these women 7 years later after village level surgery was introduced. RESULTS: Since 1991, an additional 12% of the women had undergone eyelid surgery. 44% were conducted in the village. Surgical cases since 1991 reported shorter travel times to the place of surgery, similar post-surgical problems, and fewer days in the hospital. While providing benefits to the patient, increased village eye services did not increase the rate of surgical acceptance. The women who declined surgery did not know surgery in the village was available and the perceived cost and transportation difficulties continued to be barriers. 50% of the non-acceptors stated that there was nothing that would enable them to accept surgical intervention despite the fact that 3/4 of them reported eye symptoms that interfered with their daily activities. CONCLUSIONS: The cost efficacy of village level eye services needs to be evaluated and the awareness of these services increased.

Cost-Benefit Analysis↗
PubMed2001

Recurrence of trichiasis: a long-term follow-up study in the Sultanate of Oman.

BACKGROUND: The prevalence of long-term trichiasis recurrence following tarsal rotation and electro-epilation procedures has not been determined. A non-concurrent prospective study of surgical cases of trichiasis was therefore undertaken in Oman. METHODS: A sample of 603 surgical cases of trichiasis (approximately half tarsal rotation and half electro-epilation) was followed for an average of 3.1 years to determine recurrence. Recurrence was defined as either mild (<5 lashes touching the globe) or severe (5 or more lashes touching the globe). RESULTS: Overall, 56% (95% confidence interval of 50.6%-61.0%) of all surgical cases recurred; ranging from 61.8% of tarsal rotation patients to 50.6% of electro-epilation patients. Severe recurrence was detected among 27% of tarsal rotation patients and 10% of electro-epilation patients. Recurrence was associated with female sex, residence in a high-risk region, and time since surgery. DISCUSSION: The risk of recurrence after electro-epilation and bilamellar tarsal rotation surgery is high; strategies that account for recurrence need to be introduced.

Adult↗
PubMed1992

Argon laser treatment for trichiasis.

The goal of trichiasis treatment is to eliminate misdirected cilia that irritate the eyeball. Established methods for removal of the eyelashes include epilation, electrolysis, and cryotherapy. Cryotherapy is currently the most effective method in widespread use, but has as potential posttreatment complications "visual loss, lid notching, corneal ulcer, acceleration of symblepharon formation, xerosis, cellulitis, activation of herpes zoster, skin depigmentation, and severe soft tissue reaction." (Wood JR, Anderson RL. Complications of cryosurgery. Arch Ophthalmol 1981;99:460-3.) The use of an argon laser allows more precise placement and control of the treatment, with better overall results. We reviewed the clinical course of 77 patients with a diagnosis of trichiasis, and 1 with distichiasis. We have found treatment of trichiasis with an argon laser with the patient under local anesthesia to be an effective office procedure.

Adult↗
PubMed2005

Lattice dystrophy-like localized amyloidosis of the cornea secondary to trichiasis.

PURPOSE: To report a case of stellate and branching linear corneal stromal amyloid deposits secondary to trichiasis and the use of molecular genetic analysis to exclude lattice corneal dystrophy. METHODS: Case report and review of the literature. A 30-year-old man with a history of chronic ocular irritation was found to have distichiasis, epiblepharon, and unilateral corneal amyloidosis indistinguishable from lattice corneal dystrophy. Screening of the TGFBI gene was performed to rule out a previously reported mutation associated with lattice corneal dystrophy. RESULT: A corneal biopsy performed before presentation to the authors confirmed the presence of corneal amyloidosis. Screening of exons 4, 11, 12, and 14 in the TGFBI gene identified 2 previously reported polymorphisms, Leu472Leu and Phe540Phe, but no other coding region changes. CONCLUSION: Corneal stromal amyloidosis clinically resembling lattice corneal dystrophy may be associated with trichiasis. The exclusion of a TGFBI-associated corneal dystrophy in this case, leaving trichiasis as the most likely cause of the corneal amyloid deposition, demonstrates the utility of molecular genetic analysis in confirming or refuting a presumptive clinical diagnosis.

Adult↗
PubMedDate not supplied

Treatment of trichiasis and distichiasis by eyelash trephination.

PURPOSE: To describe the methods and results of a new technique of eyelash trephination for treatment of trichiasis and distichiasis. METHODS: The medical records of all patients who underwent eyelash trephination by the authors to treat trichiasis or distichiasis were reviewed. Gender, diagnosis, number of eyelids treated, follow-up time, and surgical outcome were recorded. The technique involves boring of the affected lash follicle with a microtrephine, followed by removal of the follicle. RESULTS: The procedure was performed on 41 eyelids of 26 patients (15 females and 11 males). Patients were followed for 6 to 51 months after surgery. No recurrence was observed in 16 patients (62%) during this period. There were no adverse effects of the therapy. CONCLUSIONS: Eyelash trephination is a safe, quick, and effective method of treatment for trichiasis and distichiasis.

Adolescent↗
PubMed2005

Prevalence of cicatricial trachoma in an indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS).

BACKGROUND: Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue. METHODS: Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys. RESULTS: Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7-61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8-13.2) with trichiasis and 5 patients (3%; 95% CI 0.5-5.5) with corneal opacities. CONCLUSION: This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.

Adult↗
PubMed2004

One year recurrence of trachomatous trichiasis in routinely operated Cuenod Nataf procedure cases in Vietnam.

BACKGROUND: Recurrence of trichiasis following surgery remains unacceptably high, regardless of the surgical procedure. Few prospective studies of sufficient size are available to assess the rate of recurrence and the factors contributing to recurrence. A prospective study of the modified Cuenod Nataf surgical procedure was conducted in Vietnam to determine recurrence and co-factors. METHODS: The prospective study of Cuenod Nataf surgery for trachomatous trichiasis took place in four districts of Vietnam. All patients from identified villages who had surgery were followed for a period of 1 year. 10 Surgeons using standard techniques and recording procedures carried out the surgery. The presence of an eyelash touching the eyeball in the operated eye was considered as recurrence. Information on all subjects was recorded preoperatively, intraoperatively, and postoperatively. An independent examiner recorded postoperative information. Relative risks were calculated to assess the contribution of various risk factors to recurrence (by eye and by person). Cox proportional hazards modelling was used to assess the independent contribution of relevant factors to the outcome. RESULTS: 471 individuals had trichiasis surgery; 463 were followed for a period of 1 year. Overall, the recurrence rate was 10.8% (95% CI 8.0 to 13.6). Among people having surgery recurrence (one or both eyes) was most common in the most elderly (relative risk (RR) 2.49) and among those with a history of previous surgery (RR = 2.49). Cox proportional hazards analysis (by eye) revealed that visual acuity, conjunctival scarring, and suture adjustment were associated with recurrence at 1 year. CONCLUSION: The Cuenod Nataf procedure, which is well accepted in the community and by eye care providers in Vietnam, has an acceptable 1 year success rate. Individuals with severe conjunctival scarring have the highest rate of recurrence suggesting that other surgical approaches are needed to manage these patients or that these patients need to be educated regarding the risk of recurrence. Active follow up of these patients would be warranted. The association with suture adjustment requires further investigation.

Adult↗
PubMed2006

Uptake of trichiasis surgical services in Tanzania through two village-based approaches.

AIM: To determine the effectiveness of village-based strategies (using school teachers and village leaders) to increase the use of surgical services. METHODS: A cohort study was conducted in Tanzania using two village strategies (village leader and school teachers); trichiasis surgical uptake and the factors associated with uptake were measured after 1 year. RESULTS: The trichiasis surgical coverage at baseline was 16.9%; 200 patients who needed surgery were identified. One year later, we were able to re-examine and interview 163 of these patients. The surgical uptake among these patients was 44.8% (95% CI 37.2% to 52.4%). Patients in the school-teacher programme had a 36.5% uptake compared with 52.1% for those in the village-leader programme. No difference was observed in uptake by age or sex. Uptake was highest among those coming from multiple-generation households and those with more household wealth. Of the 90 people who still had not had surgery, 20 (22.2%) reported seeking surgery, but failing to receive it because of barriers at the provider side. CONCLUSIONS: Improved surgical uptake for trachomatous trichiasis was achieved by using village-based promotion efforts and surgical services at existing health clinics. Even with free surgery at health clinics, indirect costs and social support barriers limit utilisation by the most vulnerable, the poorest and those living in single-generation households. Problems at the provider level also create barriers for patients who need surgery.

Adult↗
PubMed1991

Anatomical factors influencing development of trichiasis and entropion in trachoma.

There has been no published investigation into the reasons why some patients with severe trachomatous conjunctival scarring develop entropion and trichiasis while others do not. In a population of leprosy patients with severe trachomatous conjunctival scarring the authors found that lagophthalmos correlated with the absence of trichiasis and entropion. We suggest that orbicularis oculi muscle function, as well as other anatomical variations among individuals, may contribute to the development of trachomatous entropion and trichiasis in patients with conjunctival scarring.

Adult↗
PubMed1994

Cryotherapy for trichiasis in ocular cicatricial pemphigoid.

Trichiasis is a common and potentially sight threatening complication of ocular cicatricial pemphigoid and is usually secondary to cicatricial entropion. This study aimed to assess the success and complications of eyelid cryotherapy for trichiasis in a group of patients with long term follow up. The case records of all patients with ocular cicatricial pemphigoid that attended the external disease clinic at Moorfields Eye Hospital from 1980 to 1992 were reviewed. Each eyelid was divided into three horizontal zones. Cryotherapy was delivered with an Amoilette cryoprobe for approximately 30 seconds. Failure of the cryotherapy was defined as a regrowth of the eyelashes within the treated zone that either required epilation for symptom control or caused keratopathy. Ninety two lid zones were treated, involving 25 lids of 12 patients. The cumulative chance of success decreased rapidly to 40% over the first year. Thereafter, the chance of success declined slowly to 34% at 4 years. Complications included lid notching (n = 2), tarsal atrophy (n = 1), altered lid contour (n = 1), and temporarily raised intraocular pressure (n = 1). All patients had quiescent disease at the time of the cryotherapy and no patients showed increased conjunctival disease activity after treatment. Six patients were taking systemic immunosuppression medication. When ocular cicatricial pemphigoid is quiescent, lid cryotherapy has an acceptable complication rate. The major reason for recurrence of the trichiasis was attributed to inadequate follicle freezing.

Aged↗
PubMed1999

[Corneal amyloidosis complicated by trichiasis--immunohistochemical identification of the amyloid light chain protein].

PURPOSE: To identify the amyloid protein of the corneal amyloidosis complicated by trichiasis. METHODS: The two patients were 41-year-old and 38-year-old women with trichiasis. They had gelatinous drop-like corneal change in hemilateral eye. The lesion was excised and examined by light and electron microscopy. Additionally, we performed an immunohistochemical study with immunofluorescence techniques using cryosections. RESULTS: The amyloid deposits were confirmed with light and electron microscopy. Congo red positive staining was not reduced following pretreatment with potassium permanganate. Immunohistochemically, amyloid deposits in the cornea stained positively with serum human light chain kappa and lambda. Pretreatment of the section with 0.05% Tween-20 did not decrease the staining with fluorescence. The deposits stained negatively with serum prealbumin and keratin antibodies. CONCLUSIONS: These findings indicate the protein of the corneal amyloidosis complicating trichiasis to be an amyloid light chain (AL) protein that has never been identified in this kind of corneal amyloidosis.

Adult↗
PubMed2003

[A case of corneal lactoferrin amyloidosis secondary to trichiasis].

PURPOSE: A case of corneal lactoferrin amyloidosis secondary to trichiasis is reported. CASE: A 30-year-old male suffered from trichiasis with an elevated gray whitish lesion just under the center of the cornea in his right eye. The lesion had an irregular surface. METHOD: We excised the corneal lesion, and studied the excised corneal lesion morphologically. RESULT: The deposit observed just under the corneal epithelial layer was positive for Congo red staining, and showed dichroism under polarizing microscopy. The deposit also showed a immunoreactivity against anti-human lactoferrin antibody. CONCLUSION: The morphological study proved that the deposits under the corneal lesion were derived from lactoferrin. Long term injury of the corneal surface by trichiasis may lead to the deposition and structural changes of lactoferrin originating from tears.

Adult↗
PubMed1979

The use of liquid nitrogen cryospray for treatment of trichiasis.

Cryosurgical destruction of eyelashes has been successful using a double freez-thaw liquid nitrogen spray technique. While other cryogens are successful in treating trichiasis, they are contraindicated in the treatment of malignant eyelid lesions. If the clinician intends to treat both these entities, it would be simpler to use a liquid nitrogen unit; otherwise, two separate cryosurgical instruments would be required. The liquid nitrogen treatment requires two cycles of a rapid freeze to -15 degrees C coupled with a slow thaw and has given us a 90%+ success rate. Contraindications in treating trichiasis with cryotherapy include paralytic lids and heavily pigmented patients. In general, we do not treat trichiasis involving less than one-third of the lid, especially with young, healthy-appearing lid margins.

Cryosurgery↗