Eyelashes serve several purposes for the human eye. They prevent dust and other foreign objects from entering the eye. They sense touch and thus aid in the protective blink reflex. And, they add to the cosmetic appeal of the human face and to the perception of beauty. In certain conditions, however, eyelashes can cause problems for and can even be dangerous to the eye. These conditions are called trichiasis and distichiasis.
Trichiasisis a condition of abnormal eyelash growth where the lashes are misdirected and grow inward toward the eye.
Distichiasisis a condition of abnormal eyelash growth where an extra set of lashes grows behind the normal lashes in the eyelid. These “extra” lashes also grow inward toward the eye.
In both trichiasis and distichiasis, lashes can reach the surface of and rub continuously or intermittently on the eye. These lashes are rough and disrupt the surface of the eye. This disruption can lead to problems ranging from mild discomfort and foreign body sensation to infection to permanent damage to the eye from scarring and vision loss.
What Causes These Conditions?
The most common answer to this question (as in many medical conditions) is, “I don’t know.” More often than not, inverted lashes are seen as an isolated issue without a known cause. Fortunately, once these lashes are permanently removed, they usually do not come back.
There are many known causes of trichiasis, however, some of which are included below:
- Heredity — Some people are born with misdirected lashes. Others develop them later in life. (Some breeds of dogs and cats are even prone to misdirected eyelashes!)
- Injury — After an injury, scar tissue can develop causing eyelashes to grow in the wrong direction.
- Surgery — Similar to an injury, scar tissue can develop after eyelid surgery causing eyelashes to grow in the wrong direction.
- Inflammation — Many different conditions can lead to inflammation and scarring that can cause lashes to grow in the wrong direction. These conditions include but are not limited to the following:
- Bacterial Infections
- Viral Infections, such as Herpes and Shingles
- Autoimmune Diseases
- Blepharitis (Inflammation of the Eyelids)
**A note on Entropion: Entropion is a condition in which the eyelid turns inward toward the eye. This also causes lashes to rub against the eye. Entropion causes symptoms and potential issues similar to that of trichiasis. However, it is a different condition that must be treated in a different way, usually through surgical repair of the affected eyelid by a qualified eyelid surgeon. Please refer to the section of the webpage on entropion for more information on causes and potential treatments with the fellowship-trained eyelid surgeons at Florida Eye Specialists and Cataract Institute.
**A note on Trachoma: Trachoma is the term for a bacterial eye infection that causes scarring on the inside of the eyelid that can ultimately cause lashes to grow inward toward the eye. Although uncommon in developed countries, trachoma is the most common infectious cause of blindness worldwide. It affects the poorest and most remote areas of 55 countries in Africa, Asia, Australia, the Middle East, and Central and South America.
Africa is the most vulnerable continent, with 18 million cases of trachoma or 85 percent of all global cases. Each village in central Tanzania alone has between five and 20 people with reversed lashes caused by trachoma.
What are the Symptoms of Trichiasis?
- Foreign Body Sensation (i.e. feeling as though something is constantly in your eye)
- Itchy or Watery Eyes
- Discharge from the Eyes
- Sensitivity to Light
- Blurry Vision
- Sharp Pain
What are the Treatments for Trichiasis?
Treatments for trichiasis range from a simple office procedure to surgical lash removal.
First line treatment for trichiasis is removal of the inward growing lashes with forceps at a special microscope called a slit lamp in your ophthalmologist’s office. (Don’t try this at home as you may scratch your eye!) This is only a temporary solution, unfortunately, because the lashes typically grow back in 4-6 weeks.
If the lashes do recur, your options include repeated removal at the slit lamp every 4-6 weeks or permanent lash removal. There are several methods for permanent lash removal, and the best method is determined for each individual patient based on the location and number of misdirected lashes.
Options for permanent eyelash removal include the following:
- Micro-Cauterization — A microscopic cautery tip is used to heat and destroy the lash follicle so that it can no longer grow lashes. This is performed at the slit lamp office with local numbing of the lid. This procedure is very effective at removing lashes, although occasionally more than one session is required to permanently remove all lashes. Downtime is minimal after this procedure with most patients having a small amount of bruising and soreness.
- Radiofrequency Ablation — This is a very similar procedure to micro-cauterization where radio waves are used to heat and destroy the lash follicle.
- Laser Cauterization — This is a very similar procedure to micro-cauterization where a laser is used to heat and destroy the lash follicle.
- Cryoablation — This procedure is performed for more extensive areas of trichiasis where there are too many misdirected lashes for the above procedures to be effective. The areas of misdirected lashes are frozen so that they cannot regrow lashes. Patients usually have swelling and discomfort for 1-2 days after this procedure. The downside of this procedure is that normal lashes can be lost along with abnormal ones. This procedure generally takes multiple treatments to be completely effective.
- Surgical Excision — Surgical excision is also effective for removing larger areas of misdirected lashes. This can be performed in our office surgery suite or in the operating room depending on patient preference.
What to Know About Inward-Growing Lashes
In 2010, there were an estimated 8.2 million people with this condition. Untreated, it can potentially become a serious problem. However, with prompt diagnosis and proper treatment, trichiasis and distichiasis can be effectively managed without any permanent damage to the eye or to the vision.
At Florida Eye Specialists and Cataract Institute, one of our highly skilled physicians can diagnose your condition and will determine if you are suffering from trichiasis or distichiasis. He or she will then be able to determine if there has been any damage to the eye(s) and how to protect the eye(s) going forward. He or she can then refer you, if necessary, to one of our Fellowship-Trained Eyelid Specialists, who can provide the most effective treatment for your condition.
Florida Eye Specialists and Cataract Institute would like to alleviate any concerns you may have about surgery:
• Surgery for this condition generally takes less than 15 to 20 minutes per eye and often takes much less time
• Surgery is most commonly performed under local anesthesia and pain is short-lived, usually lasting less than 1-2 days
• Surgery is only on the lid, not on the eyeball
• You can go home 1-2 hours after surgery
• You can generally go back to work either the day of or 1-2 days after surgery
Florida Eye Specialists and Cataract Institute suggests that you can take the following proactive measures to reduce the chance of eye infection:
- Wash your hands before putting in or taking out your contact lenses or taking them out
- Don’t use eyelash curlers — It is easy to accidentally curl lashes the wrong way. If you already have lashes that curl downward, this tool can aggravate the problem.
- Skip the false eyelashes — False eyelashes stick to thelash line with gummy glue. This glue contains formaldehyde, which can cause irritation and allergic reactions.
- Clean makeup brushes once a week with gentle soap and warm water. Then, let them air dry. Dirty brushes can cause infections.
- Never share makeup.
- Before going to bed, completely wash off your makeup with gentle soap and warm water. You can also use eye makeup remover wipes, which can be purchased online or at a drugstore.
At Florida Eye Specialists and Cataract Institute our passion is to help our patients feel their best and enjoy their best lives. It’s clear to see there is only one choice in eye care.
**Please note that not all the information in this article is appropriate for everyone. This article is not a substitute for actual in-person medical treatment. If you are concerned about this or another ocular issue, please contact Florida Eye Specialists and Cataract Institute immediately to schedule an in-person evaluation.