Trichiasis, a very common lid abnormality, is defined as the misdirection of eyelashes toward the globe. The misdirected lashes may be diffuse across the entire lid or in a small segmental distribution.
Trichiasis may result from chronic blepharitis, burns, eyelid laceration, trachoma, cicatricial pemphigoid, Zoster, and Steven-Johnson syndrome. Patients complain of watery, red, and irritated eyes because the offending eyelashes rub against the eye.
Many procedures for the repair of trichiasis have been described. Lash and follicle destruction surgery is preferred for segmental or focal trichiasis.
Simple epilation with forceps often leaves the lash follicle and usually is only a temporizing measure. The lash often grows back even more irritating with a short harder edge. Cryosurgery of lashes and follicles can be very effective, but also destroys the adjacent tissues. Radiofrequency ablation of lashes and follicles with the ellman surgitron is extremely effective and can be performed quickly and easily at the slit lamp or with surgical loupes and local anesthesia. The smallest gauge wire is introduced alongside the lash down to the follicle, with the lowest setting that gives an easy introduction of the wire. In some severe cases, additional surgery may be required to fix this problem.