Time-consuming eyelashes: an audit of trichiasis management

Mona Khandwala, Sarju Dey, Muddassar Hussain, Carole A Jones

Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK


Purpose: To assess the efficacy, appropriateness, and efficiency of treatment for trichiasis in the ophthalmic department of a UK general hospital.

Methods: Fifty-nine patients with trichiasis were treated between September 2005 and September 2006. A case note review identified the cause of trichiasis and classified patients into those with lid malposition (n = 10) and those with lash distortion (n = 44).
We audited for effective treatment (relief of symptoms which allowed patient discharge), appropriate treatment (≤ 3 epilations before treatment review, 1–5 aberrant lashes electrolysed, >5 aberrant lashes treated by cryotherapy, all patients with lid malposition referred to the oculoplastic clinic, and listed for surgery), and efficient treatment: (<3 epilations and <4 electrolysis treatments or a single operation prior to discharge).

Results: For patients with lid malposition, 80% were discharged after one operation, 80% were listed appropriately, and 87.5% patients were efficiently treated. For those with lash distortion, the success rate was 54% with epilation alone and with electrolysis, whilst success with cryotherapy was 78%. Prior to electrolysis, on average a patient attended 10 times for epilation. Cryotherapy was utilized after an average of three electrolysis treatments. The average number of patient visits for epilation was 5 (range 1–26). The average number of patient visits for electrolysis was 2 (range 1–6).

Conclusion: Patients with lid malposition were managed well. Epilation alone was undertaken inappropriately, resulting in inefficient treatment and unnecessary clinic visits. To improve patient care, a treatment algorithm is now displayed in all clinic rooms.

Keywords: eyelash, removal, epilation, electrolysis, cryotherapy