What is trichiasis?

Trichiasis, commonly referred to as “in-turned eyelashes,” is a condition in which one or more eyelashes grow abnormally inward toward the eye rather than outward away from it. This misdirection causes the lashes to rub against the cornea (the clear front surface of the eye) and/or the conjunctiva (the thin, transparent membrane covering the sclera and inner eyelids), leading to chronic irritation, foreign-body sensation, tearing, redness, and photophobia. In severe or prolonged cases, repeated mechanical trauma can result in corneal abrasions, epithelial defects, vascularization, scarring, or even ulceration—potentially compromising visual acuity.

Trichiasis may arise from several underlying causes. The most common etiologies include chronic inflammatory conditions such as blepharitis, ocular rosacea, or trachoma (a bacterial infection caused by *Chlamydia trachomatis*, historically endemic in certain regions and a leading cause of preventable blindness worldwide). Other contributing factors include eyelid margin scarring from trauma, surgery, chemical burns, or autoimmune disorders like ocular cicatricial pemphigoid. Age-related changes—such as loss of tarsal plate elasticity or weakening of the orbicularis oculi muscle—can also lead to marginal malposition and subsequent lash misdirection, particularly in older adults.

Diagnosis is typically made clinically during slit-lamp biomicroscopy, which allows precise visualization of lash orientation, lid margin anatomy, and associated ocular surface changes. Management depends on severity, number of affected lashes, and underlying cause. Conservative options include lubricating artificial tears and temporary epilation (lash removal); however, recurrence is common with these approaches. Definitive treatment often requires procedures such as electrolysis, radiofrequency ablation, cryoepilation, or surgical interventions—including rotational flap techniques (e.g., anterior lamellar repositioning) for diffuse or cicatricial trichiasis. Referral to an ophthalmologist or oculoplastic surgeon is recommended for persistent or complex cases to prevent long-term ocular complications.