Trichiasis treatment includes mechanical hair removal, electrolysis, cryotherapy, and argon lasers, as well as various surgical approaches that may use combinations of the above. This therapy is prescribed in the case when there is an abnormal growth of eyelashes, which implies damage to the mucous and soft tissues of the eye.
Eyelash epilation methods
Mechanical hair removal is usually the first line, especially for a few isolated lashes. However, lashes usually grow back in a few weeks, and additional therapy is usually needed if the lashes come back. Electrolysis or electrolysis involves inserting a probe into each individual follicle under a slit lamp or magnification of a working microscope. After the local anesthetic has penetrated the eyelid, the probe is inserted along the hair shaft. An electrical charge is applied until bubbles are visible at the root of the hair shaft. If the hair shaft and bulb are pulled out freely, the treatment is successful.
This method has also proved to be quite effective for isolated follicles, but the procedure is very painful and can also lead to overgrowth and scarring of the eyelids. Radiofrequency hair removal is performed in much the same way and has been found to have a high success rate (56 to 90%) and cause less scarring than electrolysis.
The argon laser achieved similar success rates with limited side effects due to the precise tissue destruction. It is a suitable choice when the lashes are few and scattered, and when they are not secondary to an inflammatory condition. The argon beam is usually titrated according to cilia pigmentation, with suggested laser settings ranging from 300mW/0,5s/50µm to 1200mW/0,2-0,5s/50-100µm.
Repeated burns are needed to destroy the follicles. Reported success rates range from 45 to 62 percent after the first treatment and 68 to 70 percent after two treatments. Side effects are primarily short-term swelling and erythema (side effects are minimal compared to more destructive forms of eyelash epilation).
Several recent studies have used an 810nm diode laser instead of argon, which works by using a contact probe to direct laser energy along the lash line. According to statistics, after laser hair removal, there is a decrease in the growth of unnecessary eyelashes and recurrence is excluded, and complications are minimized.
Cryotherapy is effective for large, confluent areas of trichiasis. After injection of a local anesthetic, the probe is applied to the treatment area using a bonding gel such as Surgilube.
Then cold working begins, with thermocouples set to -20 to -30 degrees Celsius. The sleeve is held for 5 seconds and then allowed to thaw. This process is repeated, thus completing the double freeze and thaw method. Statistically, success rates range from 90 to 91 percent. However, the surrounding soft tissues are often affected, leading to:
- eyelid entropy;
- swelling of the eyelids;
- channel scarring;
- pigmentary changes in the eyelids.
Very extensive trichiasis can also be treated with surgery. Surgical techniques include eyelid wedge cutting, horizontal blepharotomy, and eyelid splitting. Surgical or radiosurgical splitting of the eyelid margin provides direct access to the eyelash follicles, which can then be effectively destroyed or extirpated internally using some of the above methods. The method for the eyelash epilation procedure is determined by the doctor, taking into account the degree of manifestation of the disease, the patient’s condition and the risks.
Symptoms and diagnosis of trichiasis
During the development of the disease, eyelashes grow in the direction of the eyeball, therefore, causing corneal erosion and irritation of the mucous membranes. Symptoms such as photophobia and blepharospasm also develop. The patient has frequent squinting and blinking. Depending on the form of the disease – partial or complete, bilateral or unilateral – differently expressed symptoms can be observed. Eyelashes are usually short, thin, their direction is chaotic.
Eyelashes that come into contact with the eyeball are usually not endowed with pigment, therefore, it is almost impossible to see them with the naked eye. Doctors use powerful magnifying lenses for examination.
During the examination, the doctor may prescribe additional studies: checking visual acuity, biomicroscopy of the edges of the eyelids, biomicroscopy of the conjunctiva and cornea using special dyes that are safe for the mucous membrane of the eye.
Prevention of trichiasis
Prevention of trichiasis consists in the correct and timely treatment of inflammatory processes of the chronic type, burns and trachomas in the eyelids. If eyelash growth causes discomfort, pain, you should contact an ophthalmologist or surgeon as soon as possible to make the correct diagnosis and select an effective and most comfortable treatment method.
It is important to understand that the later you turn to the doctor, the more difficult it is to correct the situation without serious consequences and a long recovery period.
It is important in the process of choosing a clinic for the treatment of trichiasis to pay attention to the presence of diverse diagnostic methods, to the range of methods for eyelash epilation, to the professionalism of the doctor, since the procedure can be safely attributed to surgery, and the doctor’s inexperience can seriously damage the organs of vision without the possibility of correcting the situation.
Recently, this disease often develops in newborns, therefore, parents need to carefully monitor the condition of the baby’s eyes and, at the first signs (redness, increased salivation, the child often rubs his eyes, squints, etc.), contact a pediatrician or ophthalmologist.