Trichiasis is an abnormality involving the eyelids. In trichiasis, the eyelashes are misdirected towards the eyeball. Typically, there is a single row of eyelashes lining the lower and upper eyelids. Under normal circumstances, these lashes usually point away from the eye. 
When someone with misdirected eyelashes blinks, the eyelashes rub against the cornea, the conjunctiva and the inner area of the eyelids. The cornea is the transparent window that covers the iris and the pupil. The conjunctiva is the transparent membrane that covers the white part of the eye. This results in an irritated eye.
If the condition persists, it can lead to corneal scarring. Corneal scarring, in turn, can lead to loss of vision if not treated.
Trichiasis can affect anyone although it is prevalent among adults.

Also Known As

  • Misdirected eyelashes



Causes and Risk Factors

An eye infection, trauma to the eye, inflammation of the eyelid and autoimmune conditions may may lead to trichiasis. Aging may also be a cause as the skin's elasticity tends to decrease. Furthermore, previous eyelid surgery may result in the curving inwards of the eyelashes. An individual with the following conditions has an increased likelihood of developing trichiasis:
Trauma or injury to the eye - Such trauma may include burns.
Distichiasis - A congenital condition which sees the growth of an extra row of eyelashes.

  • Trachoma - An infectious disease that can lead to blindness and which is found in the rural areas of developing countries.
  • Rare skin disorders and abnormal mucous membranes - These include cicatricial pemphigoid and Stevens-Johnson syndrome.
  • The chronic form of blepharitis - A condition in which the eyelids are swollen. There is also bacteria which lines the eyelid margin close to the base of the eyelashes.
  • Entropion - It affects the lower eyelid causing the eyelid to turn inward. The growth causes the eyelashes to rub against the eye’s surface continually. The condition can lead to scarring and decreased vision.
  • Epiblepharon - A congenital disorder characterized by loose skin around the eye which forms a fold. The fold forces the lashes to take a vertical position. It is a disease that is common among children of Asian origin. 
  • Herpes zoster ophthalmicus - An eye disease caused by the herpes virus 3, the same virus that results in chickenpox. The individual develops a rash around the eye area which may be accompanied by pain, inflammation and loss of vision.

Signs & Symptoms

The following are the symptoms of trichiasis:

  • Redness in the eye
  • Pain when exposed to light
  • Abnormal or excessive tearing
  • Irritation and discomfort to the eye
  • Photophobia or sensitivity to bright light
  • Sensation or feeling of a foreign object in the eye


The eye care professional may diagnose trichiasis by doing a careful physical examination. Trichiasis resembles similar diseases such as entropion, distichiasis and epiblepharon. The professional can use fluorescein staining to rule out corneal abrasions and ulcers. The professional should also pay close attention to the lid margin structures which distinguishes trichiasis from other similar diseases.


Treatment of trichiasis aims to remove the eyelashes, follicles or redirect the growth of the eyelashes.

Medical Treatment

Treatment of trichiasis depends on the number of eyelashes involved.
The eye doctor will remove the problematic eyelashes using forceps in a treatment called epilation. The procedure is done if a single or a few eyelashes are involved. It is also an outpatient procedure done in the doctor’s office. 

The patient can also regularly use artificial tear drops to prevent corneal scarring.

Surgical Treatment

Surgery is considered if the condition involves multiple eyelashes that grow towards the eye. In this case, the lashes will be removed permanently. Ablation (laser surgery) eliminates the lashes from the hair follicles they grow from. The surgeon will numb the eye in this outpatient procedure. 

Electrolysis can also successfully, permanently remove hair. The procedure involves the use of heat and an electrical current to destroy the hair follicles. However, electrolysis can be painful and it takes a lot of time.

Cryosurgery is another effective procedure that removes the follicles and eyelashes. It is done through freezing. 
A further surgical option is an operation to reposition the eyelashes whose disorder has been caused by epiblepharon. This method corrects the anatomical cause of trichiasis.
Corrective surgery is recommended if entropion has caused the disease. Entropion can damage the cornea necessitating surgery to correct the eyelid.

Prognosis/Long-term outlook

Children who are prone to trichiasis may outgrow the condition. 
If eyelashes are allowed to rub against the cornea for long periods, they may cause corneal abrasion or corneal ulcers. While abrasions are mild and may cause no significant harm, ulcers are risky because they can lead to loss of vision.
Though effective, using forceps to remove eyelashes may cause them to grow back again in the wrong direction. Eyelashes usually take about 3-5 months to develop back.
While cryosurgery can treat trichiasis, it can lead to severe lid scarring and distortion. The method is only used in a few, severe cases.

Permanently removing the problematic eyelashes may be challenging. 

A patient should continue to use artificial tear drops for several days for comfort.

A patient who has undergone a laser treatment will need to be reviewed several weeks later. The check-up is necessary to determine if the lashes are growing back.

Prevention/Follow Up