Trichiasis

Trichiasis is a factor in many cases of preventable blindness worldwide. Eyelashes that are misdirected toward the eye can scratch your cornea and cause blindness. Treatment involves removing the eyelashes.

Overview

What is trichiasis?

Trichiasis is an eye condition in which your eyelashes grow the wrong way — toward your eye rather than away from it. Having misdirected eyelashes causes your eye to become irritated because the lashes scrape against the cornea, the conjunctiva and the inside of your eyelids.

Trichiasis usually affects your lower eyelids. There’s a special name for eyelashes that grow in the inner corner of your eye — medial canthal trichiasis.

Your cornea is the clear part of the front of your eye that helps you to focus. The conjunctiva is a tissue that provides protection by making tears and mucus. It lines your eyelids and covers your sclera, which is the white part of your eye.

Trichiasis can be so harmful that it can result in low vision and even progress to blindness.

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Symptoms and Causes

What are the symptoms of trichiasis?

Common trichiasis symptoms may include:

What causes trichiasis?

Trichiasis can be caused by inflammation, infection and other eye conditions. These include:

  • Distichiasis: This condition means that you have an extra set or row of eyelashes. They can point toward the eye.
  • Blepharitis: This word means eyelid inflammation (swelling). Chronic blepharitis can cause your eyelashes to be misdirected.
  • Infections, such as trachoma: Trachoma, a bacterial infection that’s found worldwide, can cause your eyelashes to point toward your eye.
  • Entropion: In this condition, your eyelids and your eyelashes are pointing toward the eye. Both skin and lashes irritate the surface of your eye.
  • Epiblepharon: This condition is one that you’re born with in which your eyelid muscle and skin creates an extra crease. This fold of skin makes your eyelids point upward and into your eye instead of away from your eye.
  • Herpes zoster eye disease: This condition is also called shingles of the eye. It causes swelling, pain and complications with vision.
  • Injury to the eye:Injuries may include burns, damage from chemicals and other types of accidents.
  • Diseases that affect the skin and mucous membranes: One example of this type of disease is Stevens-Johnson syndrome, which causes skin peeling.

Is trichiasis contagious?

Trichiasis isn’t contagious, but the infections that can cause it are contagious. Trachomatous trichiasis is one of the biggest causes of blindness in the world. The bacterium that causes trachoma spreads very easily among people.

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Diagnosis and Tests

How is trichiasis diagnosed?

Your eye care specialist will ask questions about your health history and your symptoms. They’ll do a thorough eye exam.

During your eye exam, your provider will be able to see which way your eyelashes are pointing and how many of them are affected. They’ll also be able to tell if your eyes are becoming damaged by the lashes.

Management and Treatment

How is trichiasis treated?

Treating trichiasis has the goal of protecting the cornea and removing the eyelashes that are pointing into the eye. Your provider may begin by prescribing lubricating eye drops. Treatment choice may also depend on how many misdirected eyelashes you have.

Tweezing or plucking to treat trichiasis

Your provider can pluck hairs out using tweezers (forceps), but this isn’t permanent. The hairs may grow back in the right direction, or they may grow back in the same position and continue to irritate the eye.

Electrolysis to treat trichiasis

Electrolysis is a way to remove hair permanently. The treatment uses an electric current to destroy the hair root at the end of the follicle.

Cryoablation to treat trichiasis

Cryoablation is a way to remove hair follicles and roots using extremely cold gas. Cryoablation, also called cryosurgery, is effective but can cause complications like scarring or changes in skin color.

Cryoablation is sometimes paired with a technique called eyelid splitting. The provider cuts into the eyelid to expose the hair follicles and then uses cryotherapy to destroy them.

Laser ablation to treat trichiasis

Your provider may suggest using lasers to remove the misdirected eyelashes of trichiasis. An argon laser was the first type of laser used to treat trichiasis. The treatment may also use infrared diode lasers, ruby lasers and Nd:YAG lasers (neodymium-doped yttrium aluminum garnet lasers).

Releasing follicle roots to treat trichiasis

Plastic surgeons have tested a newer technique for treating trichiasis that involves surgery to remove and reposition the hair follicles. The incision is glued back together.

One advantage of this treatment is that your eyelashes remain in place, so your eyelashes are fuller. Some people don’t like the way they look with fewer eyelashes. The follicle release procedure lets you keep the eyelashes you have.

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How long does it take to recover from trichiasis treatment?

You may have swelling or some pain from treating misdirected eyelashes. Recovery time for surgery should be only a few days, but you may have to restrict your activities for a longer period of time.

What complications can occur from treating trichiasis?

Complications that may occur as a result of treating trichiasis include:

  • Infection.
  • Scarring.
  • Depigmentation of skin (loss of skin color).
  • Having eyelashes where some individual lashes are missing.

Prevention

How can I prevent trichiasis?

There’s no way to stop yourself from developing trichiasis. You can’t control the way your eyelashes grow.

Outlook / Prognosis

When should I see my healthcare provider about misdirected eyelashes?

Contact your healthcare provider if you have eye irritation, eye pain or other symptoms, like watery eyes and redness. It’s important to have regular eye exams.

Additional Common Questions

What is the difference between entropion and trichiasis?

Entropion is a condition that happens when your eyelid turns inward toward your eyeball. The skin and the lashes rub against the cornea. Entropion, like trichiasis, can cause corneal abrasions and ulcers. Trichiasis really refers only to the eyelashes pointing the wrong way.

What is the difference between distichiasis and trichiasis?

If you have distichiasis, you’ll have an extra row of eyelashes. They may be smaller and point the wrong way and can scrape against the eye. Trichiasis affects your normal set of eyelashes.

A note from Cleveland Clinic

Your healthy vision is important to you and to your healthcare providers, so it’s also important to recognize any changes you experience. As is true with most healthcare issues, treating any type of eye condition early leads to better outcomes. Having a few stray eyelashes may seem unimportant, but it’s best to check with your eye care provider. Even if there’s only a mild issue, your provider can help you find a solution. If it’s trichiasis, it’s important to treat it before your eyes are damaged.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 12/05/2022.

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