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 involving multiple lashes 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 malignancy (sebaceous carcinoma) in cases of unilateral, chronic, treatment-resistant lash abnormalities with focal lash loss 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
Important Caveats
- Patients with neurotrophic corneas require careful counseling about the risk of corneal injury during any eyelash manipulation 2, 3
- Simple epilation is only temporary; patients must understand that recurrence is expected and repeated treatments or definitive procedures may be necessary 1
- If multiple lashes are misdirected or if there is associated eyelid margin scarring, referral to an oculoplastic surgeon for definitive surgical correction is appropriate 1
- Biopsy should be strongly considered for asymmetric, unresponsive cases to exclude sebaceous carcinoma, which can masquerade as chronic blepharitis 1