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Trichiasis: ingrowing eyelashes

What is Trichiasis?
The term trichiasis describes the misdirection of eyelashes such that instead of them growing outwards normally, they point inwards and touch the eyeball causing irritation, watering and discomfort

What causes Trichiasis?
There are several ways in which trichiasis can result.
  • In the UK, the commonest cause of trichiasis is marginal entropion. This is where the hair bearing skin of the edge of the eyelid, has migrated towards ocular surface. Looking from the side, the edge of the eyelid is seen to rotate slightly inwards causing the eyelashes to start pointing inwards, touching and abrading the cornea. This is quite commonly due to blepharitis or meibomian gland disease, a condition characterised by chronic inflammation of the eyelid margins which in turn causes scarring of the edge of the eyelid. This continual scarring results in migration of the eyelid marginal skin. Marginal entropion is more common in the elderly due to age related weakening of some of the stabilising tendons that keep the eyelid skin in check.
  • Injury to the eyelid can cause trichiasis, especially if the eyelid is torn near its margin. If an eyelid wound is allowed to heal in a misaligned position, the eyelashes may start to grow inwards,and rub against the eyeball.
  • Trichiasis can also arise from a rare condition called distichiasis, where an extra row of eyelashes is present These extra eyelashes may grow inwards and also rub against the eyeball.

What are the signs and symptoms of trichiasis?
• Irritation of the eyeball.
• Watering of the eye.
• Redness of the eye.
• Discomfort when looking at a bright light (photophobia). This is may be due to corneal surface damage.
• In severe untreated cases, the constant rubbing of the surface of the eye may result in corneal ulceration, which, if left untreated, may result in loss of vision.

How is Trichiasis treated?

Trichiasis can be treated in a variety of ways, depending upon the number of lashes involved, the cause of trichiasis and the preference of the patient.

If there are only 1 or 2 abnormally growing eyelashes, it may be possible to just to pluck out the offending lashes (epilation). This quick method however is jus a temporary measure, since the lashes will regrow again usually within 6 weeks.

A more permanent method of treatment to destroy a small number of abnormally growing eyelashes is by applying a small electric current using a neddle electrode next hair follicle bulb. A small injection of local anaesthetic is usually given into the eyelid prior to the treatment to ensure the procedure is pain free. An imperfect success rate of approximately 80% exists and is due to the inability to be 100% sure that the eyelash follicle bulb is receiving the damaging electrical current.


Occasionally surgery to the eyelid itself may be required to either:
• change the direction of growth of the eyelashes or
• permanently remove the eyelashes by removing the eyelash hair bearing skin
Most trichiaisis correction surgery can be done quickly and safely with very good long term results under local anaesthetic only as a day case