Trichiasis

Prepared by:Pooja Adhikari

Roll no.: 27
SMTC
 Introduction
Trichiasis is a common eyelid problem or lid abnormality.
It is a medical term for abnormally positioned eyelashes
that grow back towards the eye, touching the cornea and
conjunctiva. In the trichiasis, there is an anatomic
misalignment of eyelashes. Trichiasis can occur in all
ages however, it is most commonly seen in adult age.
Definition: It is defined as the ingrowths or introversion of
the eyelashes in which the lashes rub against the cornea,
the conjunctiva and the inner surface of the eyelids. This
cause the irritation in the eye.
 Incidence
 Africa is the worst affected continent, as 18 million
cases of active trachoma and 3.2 million cases of
trichaisis are thought to exist in 29 out of the 47
countries in african region (World Health
Organization [WHO], 2012).
 Causes
1. The exact cause of trichiasis is unknown.
2. Trachoma : It is a Commonest cause of the
trichiasis. As, it is a severe eyelid infection that can
impact the eyelashes and even cause blindness. A
repeated cases of trachoma may cause trichiasis.
3. Trauma to the eyelid: Scar tissue that develops
after an injury or trauma can cause eyelashes to
grow in different direction. Eye surgery may also
have this effect.
Cont..
4. Infection and inflammation of the eyelid
5. Developmental changes: The eyelashes and hair
follicles may temporarily change shape as a child
grows. Any resulting trichiasis is usually temporary.
6. Chronic Blepharitis: This is a common and
ongoing condition. Chronic blepharitis involves
inflammation and irritation of the eyelid in which
the eyelids become swollen and oily particles and
bacteria coat in the base of the eyelashes.
Cont..
7. Entropian : This condition causes the eyelid to fold
inward, which can lead to trichasis. Age related
muscle weakness, tissue weakness and infection or
injury can cause entropian.
8. Herpes of the eye: Herpes can infect the eye and
damage the eyelid causing trichiasis.
 Sign and symptoms
• The eye becomes red and irritated.
• Foreign body sensation with irritation in the eye.
• Sometimes pain when exposed to the light.
• Watery eyes
• Blurry vision
• Ocular discomfort
• Itching
• Conjunctival congestion
• If the condition persists, scarring of cornea can occur.
 Diagnostic Procedures
• No Specific diagnostic procedures are required in the
management of trichiasis. Some diagnostic
procedures are:
1. History Taking
2. Physical Examination
3. Slit lamp examination: It is performed to assess the
distribution of trichiatic eyelashes, to elucidate the
underlying cause and rule out differential diagnosis.
 Treatment
Treatment of trichiasis is primarily surgical. Medical
management are aimed at controlling the symptoms
and treating the underlying causes.
 Ocular lubricants, such as artificial tears and ointments
provide relief form the irritant effects of lash rubbing.
 A single dose of Antibiotics i.e, athizthromycin 20 mg/
kg up to 1g is the treatment of choice in those affected
patients.
 Doxycycline may prevent the recurrence of trichiasis
following surgery in the patients.
 Surgical Management
The surgical management for trichasis involves:
1. Mechanical Epilation: The mechanical epilation with
forceps is a simple temporary method of removing
misdirected eye lashes, but the lashes grow back in 3
to 6 weeks so, patients should be advised that lashes
will regrow, therefore epilation may need to be
repeated. As, broken cilia are often more irritating to
the cornea than mature long eyelashes. Despite these
drawbacks, epilation is cheap and is generally
acceptable to patients as treatment modality.
Cont..
2. Electrolysis: It is a procedure done by using a high
electrical current for few isolated lashes, but has a
number of drawbacks. It is also the destruction of lash
follicle by passing electric current into the lash root.
It works by passing a small amount of current
through a very fine needle into the hair follicle. This
produces heat, destroying the cells that produce hair
at the base of the follicle. It has a high recurrence rate
causing scarring of the adjacent eyelids margin. It can
be tedious for the patient as well as for the surgeon.
Cont..
3. Cryotherapy: It is a freeze treatment used to treat
number of eye problems especially retina conditions.
The cryoprobe is applied to the affected segment for
approximately 25 seconds, allowed to thaw and then
refrozen for 20 seconds. Then the lashes are
mechanically removed with forceps
Cont..
This removes the eyelashes and follicles by freezing
them. It is effective but has the potential for
complications. It is the extreme use of cold in surgery
to destroy abnormal or diseased tissue. Freon or
nitrous oxide is used to destroy the follicles by
freezing them. The complication include: edema,
necrosis, loss of skin pigmentation and loss of globet
function.
 Prognosis
• Prognosis is generally good in the trichiasis. Frequent
follow up care and immediate attention to
complications, recurrence or corneal complications
improve the long term prognosis.
• A single dose of oral azithromycin 1 g after surgery
can help to prevent recurrence rates to 1 year.
 Complications
1. Recurrent corneal abrasions.
2. Superficial corneal opacities.
3. Corneal vascularisation.
4. Non healing corneal ulcers.
 Nursing Management
• Assessment
1. Assess the patients ability to see and perform the
activities.
2. Assess the subjective findings like blurring of the
vision, watery eyes, lacrimation etc.
3. Assess the patients knowledge of the disease process
and anxiety about the diagnosis.
4. Assess the motivation to participate in the surgical
treatment or procedure.
5. Assess the history and physical examination findings.
 Nursing Diagnosis
1. Acute pain related to inflammation of the eyelid.
2. Anxiety related to surgical procedure and its
outcome.
3. Risk for injury related to decreased and blurry
vision.
 Nursing Intervention
A. Minimizing pain
1. Provide cold compress in every 2 to 3 times a day to
manage pain and swelling.
2. Antihistamine agents such as benadryl should be used
according to physician prescription.
3. Pain may occur when exposed to bright light so, it
should be minimized.
4. If there is mild cases of eye discomfort then provide
rest to the eyes and take pain relievers medication
such as Advil or acetaminophen.
B. Reducing Anxiety
1 . Provide emotional and psychological support to
reinforce a positive self image.
1. Keep the environment simple, familiar and noise
free, limit changes.
2. Remain calm and unhurried while performing any
procedures or tasks to the patients.
3. Explain the surgical interventions to the patients
and patients visitors adequately.
4. Provide adequate rest and comfortable sleep.
C. To prevent from injury
1. Assess the patient for degree of visual impairment.
2. Ensure the room environment is safe with adequate
lighting. Remove all the objects that could be
potentially hazardous.
3. Keep patients glasses and call bell within easy reach.
4. Instruct patient or family regarding safe lighting.
5. Patient should provide sunglasses to reduce glare.
 Evaluation
1. Minimized pain
2. Reduced anxiety levels
3. Free from the injury
 References
1. Wiliam L and Tandon R. Lippincott Manual of
Nursing Practice, 9th edition.
2. Williams and Williams. Brunner and siddharths
Textbook of Medical and Surgical Nursing, 12th
edition.
3. Neil J and Kaiser k; Review of Opthalmology, 2nd
edition.
Thank you