Electrolysis outcomes for eyelid trichiasis: Consultants versus trainees.

PURPOSE: To investigate the efficacy of electrolysis for the treatment of trichiasis and distichiasis and compare success rates as a function of the eyelid treated, the indication for electrolysis and seniority of the surgeon. METHODS: The medical records of all patients who underwent electrolysis for trichiasis or distichiasis from November 2015 to November 2020 were reviewed. Sex, age, indication, eyelid treated, surgeon's educational status, number of electrolysis sessions, outcome, time between sessions and time to the last follow-up were documented. RESULTS: In total, 187 patients who underwent primary electrolysis during the study period and no prior history of trichiasis treatment were included in the analysis. Attending physicians had a significantly higher success rate after the first electrolysis session than resident surgeons (P=0.048). The success rate for patients receiving treatment of their upper or upper and lower eyelids at the same time was significantly lower than the respective percentage of patients receiving treatment of their lower eyelids (P=0.005). CONCLUSION: Improved departmental efficiency could be achieved by scheduling patients with recurrent trichiasis or distichiasis, especially of their upper eyelids, after electrolysis with an attending physician. Furthermore, improved training for ophthalmology residents in electrolysis indications and techniques would be useful.

Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal.

BACKGROUND: Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1-9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1-9 year-olds falls <5%). METHODS: Local healthcare workers conducted a population-based household survey in four districts of the Bignona Department of Casamance region to estimate the prevalence of TF in 1-9 year-olds, and TT in ≥15 year-olds. Children's facial cleanliness (ocular and/or nasal discharge, dirt on the face, flies on the face) was measured at time of examination. Risk factor questionnaires were completed at the household level. RESULTS: Sixty communities participated with a total censused population of 5580 individuals. The cluster-, age- and sex-adjusted estimated prevalence of TF in 1-9 year-olds was 2.5% (95% Confidence Interval (CI) 1.8-3.6) (38/1425) at the regional level and <5% in all districts, although the upper 95%CI exceeded 5% in all but one district. The prevalence of TT in those aged ≥15 years was estimated to be 1.4% (95%CI 1.0-1.9) (40/2744) at the regional level and >1% in all districts. CONCLUSION: With a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct.

Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji.

BACKGROUND: The WHO definition of trachomatous trichiasis (TT) is "at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes", reflecting the fact that epilation is used as a self-management tool for TT. In Fiji's Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys. METHODS: We used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji. RESULTS: We sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7-11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation. CONCLUSION: Epilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.

Trichiasis in ancient times.

Trichiasis, recognized since the time of Hippocrates, is a cause of ocular irritation that may result in scarring of the cornea and threaten sight. We have reviewed the original Greek medical texts made from the 1st to the 7th century ce and present the existing medical knowledge relating to trichiasis, including its clinical picture, cause, diagnosis, and treatment. Recognition of trichiasis as a stage of trachoma and its distinction from pseudotrichiasis gave the impetus for physicians of the era to use a significant number of pharmaceutical and surgical treatments.

Evaluation of the Effect of N-Acetylcysteine on Protein Deposition on Contact Lenses in Patients with the Boston Keratoprosthesis Type I.

PURPOSE: To establish the efficacy of topical N-acetylcysteine (NAC) as a treatment to reduce protein deposition on the contact lens surface. METHODS: In this prospective, nonrandomized clinical trial, a total of 10 eyes (9 patients) were enrolled from a single center. All patients had a prior ocular history of either a Boston Keratoprosthesis type I or trichiasis from Stevens-Johnson syndrome, which necessitated full-time contact lens wear. Four visits were required to complete the study. During visit 1, a new contact lens was inserted and a baseline examination was performed. Visit 2 served as the control month, whereas visits 3 and 4 were month 1 and 2 on treatment with 20% NAC. At the end of each visit the contact lens was replaced. The lenses from visit 2 (control month-without NAC) and from visit 3 (treatment month-with NAC) were collected for proteomic analysis. The main outcome measures were to quantify protein deposition, as well as to assess the visual acuity and ocular surface symptoms before and after treatment. RESULTS: Topical NAC resulted in a 20% decrease in protein deposition. This correlated with a trend for improvement in visual acuity and increased subjective improvement in vision at month 1 (P=0.0153) and 2 (P=0.0016). CONCLUSIONS: NAC reduced protein deposition, decreased ocular surface symptoms, and improved contact lens transparency, thereby providing increased optical clarity.

Epilation for minor trachomatous trichiasis: four-year results of a randomised controlled trial.

BACKGROUND: Trachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity. METHODOLOGY/ PRINCIPAL FINDINGS: 1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating ("epilation-only"). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (>5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years. CONCLUSIONS/ SIGNIFICANCE: Most minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment.

The effect of 0.02% mitomycin C injection into the hair follicle with radiofrequency ablation in trichiasis patients.

PURPOSE: To investigate the inhibitory effect of 0.02% mitomycin C on eyelash regrowth when injected to the eyelash hair follicle immediately after radiofrequency ablation. METHODS: We prospectively included 21 trichiasis patients from June 2011 to October 2012. Twenty eyes of 14 patients were treated with 0.02% mitomycin C to the hair follicle immediately after radiofrequency ablation in group 1, while radiofrequency ablation only was conducted in ten eyes of seven patients in group 2. Recurrences and complications were evaluated until six months after treatment. RESULTS: One hundred sixteen eyelashes of 20 eyes in group 1 underwent treatment, and 19 (16.4%) eyelashes recurred. Eighty-four eyelashes of ten eyes in group 2 underwent treatment, and 51 (60.7%) eyelashes recurred. No patients developed any complications related to mitomycin C. CONCLUSIONS: Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment in trichiasis patients.

Australian trachoma surveillance annual report, 2011.

Australia remains the only developed country to have endemic trachoma in some regions. Endemic levels of trachoma in Australia are found predominantly in remote and very remote Aboriginal communities. Data are collected from Aboriginal communities designated at risk for endemic trachoma (defined as a prevalence of 5% or greater among children) in the Northern Territory, South Australia and Western Australia. This report presents data collected in 2011. The World Health Organization (WHO) grading criteria were used to diagnose cases of trachoma in Aboriginal children with jurisdictions focusing screening activities on the 5-9 year age group. The prevalence of trachoma within a community was used to guide appropriate treatment strategies as a public health response. Aboriginal adults aged 40 years or older were screened for trichiasis. Population screening coverage for trichiasis in 2011 was 9% with a prevalence of 2% in those adults screened. Trachoma screening coverage of the estimated populationof children aged 5-9 years in at-risk communities was 65%. Trachoma prevalence among children aged 5-9 years who were screened was 7%. Of the communities screened, 47% were found to have no cases of active trachoma and 40% were found to have endemic levels. Treatment was required in 80 at-risk communities screened. Treatment coverage of active cases and their contacts varied between jurisdictions, ranging from 53% to 98%. This report provides evidence of increasing coverage of trachoma screening and control activities. In the Northern Territory and Western Australia, there is also evidence of a decline in the prevalence of infection that may be attributable to an improvement in control activities. Despite these apparent advances, trachoma prevalence remains at endemic levels in many communities in remote Australia. Continued efforts are required to ensure that Australia remains on track to reach the goal of elimination by 2020 or sooner.

Trachoma prevalence in women living in rural northern India: rapid assessment findings.

PURPOSE: Rapid assessment of cicatricial trachoma in adult females aged over 15 years in a previously hyperendemic rural area in Haryana, North India. METHODS: Ten disadvantaged villages each with a population of 3000-5000 were chosen by cluster random sampling. One thousand females, 500 between 15-30 years and the rest over 30 years in the underdeveloped parts of the villages, identified by observation and consultation, were examined for signs of trachomatous scarring (TS), trachomatous trichiasis (TT) and trachomatous corneal opacity (TCO). Examinations of both eyes were performed with the aid of a binocular loupe (2.5x magnification) for signs of trachoma, its complications and other ocular morbidities. RESULTS: Bilateral examination was carried out in all participants. About two-thirds (n = 650; 65%) of subjects did not have any signs of trachoma. The percentages of trachoma stages TS, TT and TCO were found to be 26.4%, 5.4% and 3.2% respectively. Trichiasis was observed in 54 subjects, all in the age group >30 years, and highest in the age group 66-75 years (22.8%). Females in the age group >30 years had significantly higher cicatricial trachoma compared to females <30 years (p < 0.001). Overall 59.3% of affected females had not received any treatment. Epilation and entropion surgery had been performed in 30.3% and 10.4% of affected females, respectively. CONCLUSION: The results of our rapid assessment suggest that the presence of cicatricial trachoma remains an important health issue in females over 15 years of age.

Epilation for trachomatous trichiasis and the risk of corneal opacification.

PURPOSE: Eight million people have trachomatous trichiasis (TT). The World Health Organization (WHO) recommends entropion surgery for TT regardless of severity. However, epilation is widely practiced for treating minor TT (1-5 lashes touching the globe). We report the frequency and effectiveness of patient-initiated epilation and its relationship to corneal opacity. DESIGN: Cross-sectional baseline data of individuals recruited to 2 randomized, clinical trials. PARTICIPANTS: We included 2556 individuals (4310 eyes) with previously unoperated TT in ≥ 1 eye. METHODS: A single ophthalmologist examined all participants for signs of trachoma using WHO grading systems with additional assessment of entropion grading, location and number of trichiatic lashes, and evidence of epilation. A questionnaire enquired about epilation practices. MAIN OUTCOME MEASURES: The association between epilation and degree of corneal opacity. Epilation practices of TT patients. RESULTS: Central corneal scarring was present in 1436 (33%) eyes. Entropion was absent/mild in 2328 (54%) eyes, moderate in 1259 (29.2%), and severe in 723 (16.8%). The median number of lashes touching the eye was 2 (interquartile range, 1-5; range, 0-133). There was clinical evidence of epilation in 3018 (70%) eyes, of which 738 (24%) were successfully epilated (no lashes touching globe). Epilation was performed frequently (at least monthly in 3311 [76.8%] eyes), by someone other than the patient (92.8%), and using locally made forceps (88.9%). Controlling for age and degree of entropion, successful epilation was associated with less corneal opacity (odds ratio [OR], 0.61; 95% confidence interval [CI]. 0.43-0.88; P = 0.007). The association was only significant in patients with severe entropion (OR, 0.07; 95% CI, 0.02-0.25; P<0.005). CONCLUSIONS: We found an association between successful epilation and less central corneal opacity. This indicates the importance of preventing eyelashes from touching the cornea, particularly in individuals with severe entropion. This is a cross-sectional study; therefore, a causative relationship cannot be concluded. However, the results suggest that among patients who decline or are unable to access surgery, and perhaps in minor TT where the management remains controversial, the provision of high-quality forceps and epilation training may be beneficial. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.

BACKGROUND: Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (

Trichiasis: characteristics and management options.

Trichiasis is a common disorder in which eyelashes or cilia arising from their normal position are misdirected toward the ocular surface. This condition frequently causes ocular surface irritation and commonly results from eyelid inflammation and scarring which disrupts the direction of growth of cilia follicles. The knowledge of eyelid and cilia anatomy is important to the success of the treatment. Management options include epilation, electrolysis, radiofrequency ablation, laser photoablation, cryotherapy and surgical removal of the offending cilia. Treatment is made by the clinician based upon the number, distribution and severity of the trichiasis. Recognition and management of the underlying cause of the trichiasis should also be addressed. Nevertheless, recalcitrant or recurrent cilia are not unusual despite a systematic approach to this condition. This article will briefly discuss trichiasis and the relevant eyelid and cilia anatomy. Subsequently, the current treatment modalities for trichiasis and their complications will be described.

Electrolysis treatment of trichiasis by using ultra-fine needle.

PURPOSE: To determine the safety and efficacy of electrolysis treatment of trichiasis by using ultrafine needle. METHODS: The medical records of 24 lids of 24 patients who underwent electrolysis treatment for trichiasis by the same surgeon (Y.S.) during the period from May 2006 through December 2008 were reviewed. The average age of the 24 patients was 59.2 years (range, 43 to 76 years). Thirteen of the patients were women. RESULTS: The results were considered satisfactory if no recurrence of trichiasis occurred for at least 6 months after the last electrolysis procedure. Sixteen of the 24 patients (66.6%) had a satisfactory result with 1 treatment. Of the 8 patients (33.3%) who had an unsatisfactory result, while 5 (20.8%) responded well to 1 additional electrolysis, 3 (12.5%) responded well to 2 additional electrolyses to the recurrent cilia. The procedure was well tolerated by the patients. All eyelids healed within 2 weeks after treatment without any scarring. Faint hypopigmentation was visible in 2 patients (8.3%). Mild notching of eyelid occurred in 4 patients (16.6%). CONCLUSIONS: Electrolysis treatment by using ultrafine (55-microm thickness) needle is an effective and safe method for treatment of trichiasis with many advantages over other recognized modalities of therapy.