Southwest, FL | Case of the Day- Trichiasis | Cataract & Refractive Institute of Florida

Dr. Croley: Hello, I'm Dr. Croley, and welcome to Case of the Day. Today we're going to discuss the patient who came in complaining that their eye was irritated and felt like something was scratching or rubbing their eye, and on exam it turns out that they had eyelashes that were turned in on the lower lid and rubbing their eye. And so that's called trichiasis, very common and happens as we get older. Usually this happens on the lower lid, very seldom does that happen that the lashes on the upper lid turn in, on a rare occasion they do, but most of the time it's on the lower lid.

Dr. Croley: So what happens is, in just a routine trichiasis, there are muscles attached, tiny little muscles attached to your lashes that keep the lashes turned in the proper direction. So, as we age, sometimes those muscles weaken and then they allow the lash to turn back the opposite way. And so then, as that rubs your eye, then obviously your eye gets red and irritated and can lead to an infection. Other causes of trichiasis could be that, typically, you have a scar on your lid, such as a scar from getting shingles or herpes zoster causes scarring of the lid when the shingles occurs on the lid and this causes the lashes to grow in the wrong direction.

Dr. Croley: If you had a stye or chalazion and this stye or chalazion caused a scar of your lid, then that could turn the lashes in as well, and other lesions as well could do that. And if you had a skin cancer or a basal cell cancer or a squamous cell cancer of the lid and that caused scarring after the surgery to where the lashes turned the wrong way, then that can also lead to trichiasis. So when someone has trichiasis, their eye is very irritated, what do we do about it? Well, if there's only one lash and the person was able to see it in maybe a high magnification mirror, they could just pluck that lash out and that would be okay. If they're unable to see it or unable to do so, then we have a couple of different ways we can treat trichiasis.

Dr. Croley: One is called cryo therapy, are freezing the area where the lashes are, so we put a freezing probe on that area of the lid and freeze that area and then let it thaw out and then freeze it a second time and that will kill the hair follicle and therefore the lashes will not grow in that part of the eyelid. A couple of disadvantages of that is is you're also going to kill the surrounding lashes, because it's going to freeze an area, also it's pretty painful afterwards, the swelling from the freezer treatment can cause some pain and so it's a little bit painful.

Dr. Croley: And so, we typically, unless there's a large area of where the lashes are turned in, do not use that system. The more common way of doing this is called an electrolysis. So that's a common thing we've heard, people wanting to get rid of unwanted hair, you take a tiny little needle and go down inside the hair follicle and then, with electrical current, then sort of cauterize just a hair follicle and kill the follicle, and that works very well. So we just see the abnormal lashes, I typically do this with a microscope, so I go in and I go down the hair follicle or the eyelash, and then we just, with a tiny wire connected to a cautery type system and then we gently cauterize that follicle, and we do each individual eyelash and that works very well.

Dr. Croley: And so this person that came in, that's what we did, we actually went in and did an epilation with a cautery and that typically works very well. So, if you have any questions about trichiasis or any other questions, you can always contact us through the website. I'll be happy to try to answer any questions that you have. If you're not having any problems, great. May God bless you with healthy eyes and great vision.