Trichiasis (ingrown eyelashes): Causes, symptoms and treatment
What is trichiasis?
Trichiasis (pronounced trih-KYE-uh-sis) is a condition in which eyelashes grow back toward the eye instead of outward. This may cause the lashes to rub against the eye’s cornea or conjunctiva, creating irritation.
Treatments and management of trichiasis vary, ranging from warm compresses and epilation to ablation or surgery. The appropriate treatment for you will depend on the severity of your symptoms.
Trichiasis is commonly referred to as "ingrown eyelashes." However, it's not the same thing as a typical ingrown body hair trapped under the skin.
Trichiasis is a condition of abnormal eyelash growth — meaning the eyelashes grow inward, which can lead to irritation of the eye. It may occur on either the upper or lower eyelid.
While it can affect children, trichiasis is more commonly found in adults. It’s sometimes related to changes that occur to the eyelids and the eyelid margins during aging.
What causes trichiasis?
Trichiasis affects people differently, and there is no single cause. Some common reasons for ingrown eyelashes include:
- Trauma to the eye (such as a burn)
- Eyelid inflammation
- Bacterial and other eye infections
- Autoimmune disorders
- Natural aging
Certain eye conditions can also increase your chances of ingrown eyelashes. They may change the shape of the eyelid, which can misdirect where (and how) your lashes grow.
While the causes of trichiasis vary, some of the most well-known include:
- Chronic blepharitis – The eyelids become red and swollen because the oil, bacteria and skin particles cover the eyelid margin near the base of the eyelashes, leaving them crusty. This may contribute to clogged follicles that don’t allow the eyelashes to grow properly.
- Entropion – Caused by aging tissues and muscles around the eye, which could induce the lower eyelid to fold inward. This can force the eyelashes and skin around the eye to touch the surface of the eye.
- Trachoma – Caused by the bacterium Chlamydia trachomatis (commonly called chlamydia) and can spread easily through direct personal contact and shared towels. This condition can scar the cornea. The scarring, in turn, can affect where and how the eyelashes grow and lead to blindness if left untreated.
- Epiblepharon – A developmental disorder that usually affects East Asian children and young adults. It causes the skin around the eye to fold, pushing the eyelashes into a vertical position, where they scratch the cornea and the conjunctiva.
- Herpes zoster eye disease – Also called shingles of the eye and can appear on the face and eyelids. Since the eyelids are thin, this condition can scar them while also affecting the eyelashes and cornea.
- Distichiasis – Occurs when an extra row of eyelashes develops and grows inward, causing irritation when they rub against the eye.
Ingrown eyelash symptoms
If you have trichiasis, you may experience the following symptoms:
- Foreign object sensation
- Watery eyes (excess tearing)
- Red eyes
- Photophobia (light sensitivity)
- Irritation
- Eye pain
Left untreated, this long-term rubbing against the cornea and inner eyelid can lead to a corneal abrasion or a corneal ulcer.
Trichiasis or a stye?
Trichiasis is the term for when an eyelash grows toward the eye rather than away. If an ingrown eyelash becomes infected, it may resemble a stye, which presents as a tender, pimple-like, red bump on or near the edge of the eyelid.
Caused by Staphylococcus (Staph) bacteria, a stye is an infection that tends to originate from unwashed hands, using expired or old makeup products or leaving makeup on for extended periods of time. Styes typically occur at the base of an eyelash follicle or within one of the eyelid’s oil glands.
While active, it’s possible for a stye to cause misdirection of the eyelashes on the affected eye. However, styes usually heal on their own after a few days without complications.
Trichiasis treatment
Mild cases of trichiasis can often be managed at home with:
- Eye drops – To reduce the irritation and protect the eye’s surface from further damage, try using eye drops (preferably with medium to high thickness to ensure they will successfully remain on the eye).
- Ointments – These work well to protect the eye at night when sleeping but tend to blur the vision during the day.
- A warm compress – This involves soaking a clean cloth in warm water and applying it to the irritated area for ten minutes; a compress can provide relief but won’t remove the ingrown eyelash.
Medical and surgical treatments
Your eye doctor can remove a misdirected eyelash with tweezers by firmly grasping the eyelash at the shaft and pulling the follicle at the root. It’s important that the eyelash is pulled completely out, not allowing the hair to break or leave any uncomfortable pieces remaining.
This is a temporary solution because eyelashes regenerate on a cycle that lasts between four and six weeks. With epilation, there is a risk that the eyelashes will grow back in the same wrong direction.
Your eye doctor can talk to you about other effective methods for removing ingrown eyelashes. More serious cases of trichiasis might require surgery or a hair-removal procedure, such as:
- Radiofrequency (RF) or laser ablation surgery – During this procedure, the eye area is numbed, and lasers or RF are used to permanently remove the affected eyelashes and hair follicles. Injections of mitomycin C into the hair follicles during RF ablation may improve outcomes.
- Electrolysis – A high-frequency electrical current removes a select number of eyelashes. In this procedure, each lash must be treated individually, which makes it a time-consuming process.
- Cryosurgery – With cryosurgery (also called cryotherapy), the eyelashes are frozen and removed with liquid nitrogen. It can cause blisters and scarring and pose other risks.
- Tarsal rotation – A horizontal incision is made in the eyelid a few millimeters from the lid margin. Then sutures are placed to rotate or "flip" the margin outward to a normal position.
- Eyelid wedge resection – A vertical, wedge-shaped area of eyelid margin tissue with one or more follicles is removed. Sutures are then placed to reposition and close the margin without notching.
Some of the latest advancements in trichiasis treatments being tested include:
- Bevel-Rotation Advancement Procedure (B-RAP) – B-RAP is a type of tarsal rotation surgery. It involves a beveled incision technique developed to reduce scar tissue from repeat trichiasis surgeries.
- Releasing follicle roots – This procedure involves dissecting or "releasing" each follicle from its surrounding tissue. They are then repositioned to point in the correct direction. Adhesive is used to hold the lashes up and in place while they heal.
When to see a doctor
Regardless of the cause, ingrown eyelashes can be painful. They may also affect your vision, especially if your eyes become inflamed or sensitive to light as a result.
It’s important to visit an eye doctor if you suspect trichiasis is the reason for your eye irritation or other symptoms. They can diagnose your condition and recommend treatment options, including home remedies to help alleviate discomfort or medical procedures for more serious issues.
