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By James Garrity, MD, Whitney and Betty MacMillan Professor of Ophthalmology, Mayo Clinic College of Medicine

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Trichiasis is an anatomic misalignment of eyelashes, which rub against the eyeball, in a patient with no entropion.

Trichiasis is most often idiopathic, but known causes include blepharitis, posttraumatic and postsurgical changes, conjunctival scarring (eg, secondary to cicatricial pemphigoid, atopic keratoconjunctivitis, Stevens-Johnson syndrome, or chemical injury), epiblepharon (an extra lower eyelid skinfold that directs lashes into a vertical position), and distichiasis (a congenital extra row of eyelashes).

Corneal ulceration and scarring can occur in chronic cases. Symptoms are foreign body sensation, tearing, and red eye.

Diagnosis is usually clinical. Trichiasis differs from entropion in that the eyelid position is normal. Evaluation includes fluorescein staining to exclude corneal abrasion or ulceration.

Treatment is eyelash removal with forceps. If eyelashes grow back, electrolysis or cryosurgery is more effective at permanently preventing recurrence.

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