What is the treatment for an ingrown eyelash?

Treatment of Ingrown Eyelash (Trichiasis)

The definitive treatment for ingrown eyelashes is mechanical removal through epilation (plucking) of the misdirected lash, with more permanent options including electrolysis, cryotherapy, or surgical procedures for recurrent cases. 1

Immediate Management

Mechanical Removal

• Epilation (plucking) of the offending eyelash is the first-line treatment using fine forceps to grasp and remove the misdirected lash from its follicle 1
• For adherent or difficult cases, cutting the lash at its base with Westcott or other microsurgical scissors can provide temporary relief 1
• This provides immediate symptom relief but the lash will regrow in 4-6 weeks, often in the same misdirected position 1

Supportive Care During Acute Phase

• Apply lubricating ointments (petrolatum, erythromycin, or bacitracin) to protect the corneal surface from mechanical irritation 1
• Warm compresses for 5-10 minutes once or twice daily can reduce associated eyelid inflammation 2
• Topical antibiotics may be indicated if corneal abrasion or secondary infection is present 2

Definitive Treatment for Recurrent Cases

When Simple Epilation Fails

• For lashes that repeatedly regrow in a misdirected position, permanent destruction of the hair follicle is indicated 1
• Electrolysis can permanently destroy individual lash follicles 1
• Cryotherapy is effective for destroying multiple adjacent follicles 1
• Surgical options include wedge resection or eyelid margin rotation procedures for extensive trichiasis 1

Critical Evaluation Points

Assess for Underlying Causes

• Examine for chronic blepharitis with eyelid margin changes, as this commonly causes lash misdirection 1
• Look for eyelid malposition (entropion) that may be directing otherwise normal lashes inward 1
• Check for cicatricial changes from previous inflammation, trauma, or chronic medication use that can distort the eyelid margin 1
• Consider sebaceous carcinoma in cases of unilateral, chronic, treatment-resistant lash abnormalities with focal lash loss (ciliary madarosis) 1

Document Corneal Impact

• Perform fluorescein staining to identify corneal epithelial defects or punctate keratopathy from chronic mechanical irritation 1
• Assess for corneal scarring or vascularization in longstanding cases 1

Common Pitfalls to Avoid

• Do not simply trim the lash - this leaves a sharp stub that can cause more corneal irritation than the full-length lash 1
• Avoid aggressive eyelid manipulation in patients with advanced glaucoma, as this can increase intraocular pressure 2, 3
• In patients with neurotrophic corneas, counsel carefully about gentle technique to avoid additional corneal epithelial injury 2, 3
• Do not miss underlying eyelid malposition - treating individual lashes without correcting entropion will result in continued problems 1

Follow-Up Strategy

• Re-examine within 2-4 weeks after initial epilation to assess for lash regrowth and corneal healing 1
• If the lash regrows in the same misdirected position after 2-3 epilation attempts, proceed to permanent follicle destruction 1
• Monitor for development of new misdirected lashes, which may indicate progressive underlying eyelid disease 1