Trichiasis Surgery in London

Treating lashes that grow inward

Trichiasis is the term given to lashes that grow inward towards the eye when the eyelid is in a normal position. A number of different conditions can cause the lashes to grow against the ey but these are not termed trichiasis. They include:

 

Entropion - where the eyelid is turned towards the eye making the normal lashes rub against it.

Epiblepharon - an extra fold of skin to the lower eyelid pushes the normal lashes towards the eye.

Distichiasis - an extra row of lashes on the inner margin of the eyelid are present that can rub against the eye.

Trichiasis is where none o the above conditions are present and one or more lashes are misdirected towards the eye.  Trichiasis can cause the following symptoms:

Irritation

Redness

Tearing

Light sensitivity

Trichiasis is caused by:

Infection - Long standing (Chronic) infections such as Herpes Zoster eye disease can cause trichiasis. Trachoma which is a disease more prevalent in developing nations is known to cause trichiasis.

Eyelid inflammation - Trichiasis can develop in chronic blepharitis which is a common condition resulting in inflammation of the eyelid margin. The lashes become misdirected as a result on the long term inflammation.

Autoimmune conditions - Rare disorders affecting the skin and mucous membranes such as Steven Johnson's syndrome and cicatricial pemphigoid can result in trichiasis with the eyelashes turning in..

Injury - Burns in particular affecting the eyelid can result in trichiasis and the misdirection of the eyelashes.

Why is trichiasis surgery done

Ingrowing lashes can be plucked or epilated but this only provides short term relief until they grow back. Ocular lubricants can also be used for comfort but the permanent treatment is usually surgery.

Risks

Risks of trichiasis surgery include:

Infection

Bleeding from the surgery

Dryness and irritation of the eyes

Scarring 

Eyelid notching

Skin discolouration

Facial asymmetry

A need for follow up surgery

Temporary blurring of the vision

Rarely, loss of vision

Risks associated with surgery more general including anaesthetic reactions and blood clots

To know which risks most apply to you talk to your doctor to understand more about trichiasis surgery  as well as the benefits and if they apply to you. This way you can decide with your doctor if trichiasis surgery is a good option.

How you prepare for trichiasis surgery

Before having trichiasis surgery you will meet your Oculoplastic surgeon such as Mr Ahmad Aziz in his London clinic who specialises in trichiasis surgery to discuss:

Your medical history including any previous surgery and current eye conditions.

Your expectations with an honest discussion about what can be realistically achieved.

A vision examination to check the eyes prior to surgery.

A physical examination of  the eyelids to ensure that this is the correct procedure.

Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.

It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during trichiasis surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your trichiasis surgery and will tell you how long before the operation.

Stoping smoking several weeks before surgery can help improve the healing after trichiasis surgery.

You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.

What you can expect before the procedure

Trichiasis surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your eyelids to numb the area and you can also have medication through a drip to help you relax depending on the surgery that is to be done.

What you can expect during the procedure

Depending on the number of ingrowing lashes causing trichiasis and their location along the eyelid the following procedures may be performed:

Electrolysis - this is where a fine probe that uses radiofrequencies is inserted into the lash root to ablate it and destroy the lash follicle. This prevents further eyelash growth from the eyelash root.

Cryosurgery - freezing of the eyelashes and follicles damages them and prevent further lash regrowth. 

Lash root excision - an incision is made along the margin of the eyelid and the lash roots along the area of trichiasis are removed.

Wedge excision - if the trichiasis is in a localised area of the eyelid and there is laxity of the eyelid which is common with the ageing process, a section of the eyelid containing the area of trichiasis is removed and the remaining healthy eyelid stitched together again.

What you can expect after the procedure

After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.

After surgery you may temporarily experience:

  • Blurred vision from the lubricating ointment applied to your eyes at the time of trichiasis surgery

  • Watering of the eyes

  • Sensitivity to light

  • Double vision

  • Puffy, numb eyelids from the anaesthetic and trichiasis surgery

  • Swelling and bruising similar to having black eyes which will settle within a week

  • Pain or discomfort

Your doctor will likely suggest you take the following steps after surgery:

  • Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling

  • Gently clean your eyelids and use prescribed medication.

  • Avoid straining, heavy lifting and swimming for a week after ectropion surgery.

  • Avoid strenuous activities, such as aerobics and jogging, for a week.

  • Avoid smoking.

  • Avoid rubbing your eyes.

  • Not to use contact lenses for about four weeks after surgery.

  • Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.

  • Sleep with your head raised higher than your chest for 3 days after the surgery.

  • After a few days, return to the surgeon to have stitches removed, if needed.

Seek medical attention immediately if you experience any of the following:

  • Shortness of breath

  • Chest pain

  • An unusual heart rate

  • Severe new eye pain

  • Bleeding

  • Vision problems

Results

Many patients are satisfied with the results of trichiasis surgery and benefit from a more natural appearance, better vision if the vision was affected. The results of the surgery can last a lifetime but for others the trichiasis may recur with time particularly if the process that caused the trichiasis is ongoing or if you have had just one treatment of electrolysis.

The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. 

Scars from the surgery can take months to fully fade but should be within the skin crease or under the lashes and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.

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